Podcasts about Virginia Commonwealth University

Send us a textEpisode Summary: In this episode, Sergeant Jessica Shehan, a Public Information Officer for the Virginia State Police, shares her journey into law enforcement and the unique challenges of her role. She discusses the importance of transparency in communication, the impact of social media on public relations, and her experiences in recruitment and community outreach. Jessica emphasizes the rewarding nature of her job and the continuous learning involved in adapting to modern communication methods. In this engaging conversation, Jessica Shehan discusses her efforts to revive community engagement through the Special Olympics, the challenges of recruiting volunteers, and the use of technology and AI in public information roles. She shares her aspirations for professional development and the ongoing recruitment challenges law enforcement faces. The discussion concludes with rapid-fire questions that reveal personal insights and reflections on leadership and community service.Jessica's BIO: I joined the Virginia State Police in 2006 after graduating from Virginia Commonwealth University. Over the years, I have served in various roles, including recruitment, which has helped prepare me for my current Division 1 Public Information Officer position. I love my position, and I am excited to be leaning toward new training to expand my knowledge. In my spare time, I teach Spin and enjoy working out. I am also a wife and full-time mother to two beautiful daughters and three energetic dogs.jessica.shehan@vsp.va.govThe Brandon T. Adams Audio ExperienceWelcome to The Brandon T. Adams Audio Experience, hosted by entrepreneur, investor,...Listen on: Apple Podcasts SpotifySupport the showOur premiere sponsor, Social News Desk, has an exclusive offer for PIO Podcast listeners. Head over to socialnewsdesk.com/pio to get three months free when a qualifying agency signs up.

Building Gene's Dispensary: Community, Curation, and Creating New Art Spaces in Los Angeles with Keith J Varadi In this wide-ranging conversation on What's My Thesis?, host Javier Proenza welcomes artist, curator, and writer Keith J. Varadi, founder of Gene's Dispensary, for an illuminating discussion on forging alternative pathways in the contemporary art world. Through candid reflection, Varadi shares their journey from painting to sound art, music, and ultimately to the establishment of their independent gallery space in Los Angeles—a project that has rapidly become a vibrant hub for creative cross-pollination. Drawing on years of experience as both a practicing artist and an accomplished curator—with writing credits in Carla, Flash Art, Kaleidoscope, and Los Angeles Review of Books—Varadi discusses how health challenges, a deep commitment to community-building, and a rigorous interdisciplinary ethos led to the creation of Gene's Dispensary. Operating in the heart of Los Angeles at 2007 Wilshire Boulevard, Unit 820, Gene's Dispensary takes inspiration from DIY spaces, Black Mountain College, and the inclusive spirit of early L.A. dispensary culture. Over the course of the episode, Varadi reflects on studying at Rutgers and Virginia Commonwealth University, their experience living in New York and Pittsburgh, and the evolving sense of belonging they found upon relocating to Los Angeles. Topics explored include the challenges and possibilities of starting an art space without institutional funding, building a collector base from scratch, integrating musicians, comedians, and writers into gallery programming, and the nuances of L.A.'s cultural landscape compared to New York. Highlights include a behind-the-scenes look at Gene's Dispensary's chess tournaments, multidisciplinary performances, and the gallery's mission to dissolve boundaries between visual art and other forms of creative practice. Varadi also offers insight into the gallery's namesake, paying homage to socialist leader Eugene V. Debs and affirming a commitment to equitable practices within the art market. Whether you are an artist seeking alternative models of sustainability, a curator interested in community engagement, or simply an art lover curious about the dynamic intersections of creativity in Los Angeles, this episode offers a compelling portrait of persistence, generosity, and invention. Visit Gene's Dispensary:

Learning Objectives:By the end of this series, listeners should be able to discuss:The physiologic rationale supporting the use of airway pressure release ventilation (APRV) in ARDS. The patient populations most likely to benefit from APRV.Key published evidence that informs our use of APRV in critical care.An expert approach to managing a patient with APRV.Next steps in research that will direct our understanding of the use of APRV in pediatric critical care.About our Guest: Dr. Palen Mallory is an assistant professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. She completed medical school at Virginia Commonwealth University, a pediatric residency at Emory University, and a critical care fellowship at Vanderbilt University. She is interested in respiratory care research, including ECMO, respiratory failure, and ARDS.Selected References:Mallory, P., & Cheifetz, I. (2020). A comprehensive review of the use and understanding of airway pressure release ventilation. Expert Review of Respiratory Medicine, 14(3), 307–315. https://doi.org/10.1080/17476348.2020.1708719Frawley, P. M., & Habashi, N. M. (2004). Airway pressure release ventilation and pediatrics: Theory and practice. Critical Care Nursing Clinics of North America, 16(3 SPEC. ISS.), 337–348. https://doi.org/10.1016/J.CCELL.2004.04.003Fredericks, A. S., Bunker, M. P., Gliga, L. A., Ebeling, C. G., Ringqvist, J. R. B., Heravi, H., Manley, J., Valladares, J., & Romito, B. T. (2020). Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 14. https://doi.org/10.1177/1179548420903297APRV Guideline - EMCrit Project. (n.d.). Retrieved March 30, 2025, from https://emcrit.org/squirt/aprv/Andrews P, Shiber J, Madden M, Nieman GF, Camporota L, Habashi NM. Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal. Front Physiol. 2022 Jul 25;13:928562. doi: 10.3389/fphys.2022.928562. PMID: 35957Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Curator, writer, and executive director Jessica Bell Brown returns to reflect on her evolving leadership at the Institute for Contemporary Art at Virginia Commonwealth University. In this conversation, we talk about openness as a strategy, the role of listening in shaping institutions, and what it means to make space for experimentation in times of uncertainty.Jessica shares how porosity, risk, and care shape her curatorial and executive approach—from expanding access beyond traditional art forms to launching chef residencies and community media programs at the ICA. We discuss the influence of her time at MoMA and the Baltimore Museum of Art, the power of contemporary art to respond to crisis, and why joy and curiosity remain central to her vision.Topics Covered:What leadership looks like through the lens of listeningExpanding access to arts beyond galleries and into kitchens and podcastsNavigating risk and limitation in an age of shrinking arts fundingThe evolving responsibility of cultural institutionsThe importance of reflection, care, and creative openness

Metabolic dysfunction-associated steatotic liver disease (MASLD), also known as fatty liver disease, is a chronic liver condition that affects nearly 1 in 3 people worldwide. It is closely linked to obesity, type 2 diabetes, and metabolic syndrome. Unchecked, it can progress to a more severe form of disease called Metabolic Dysfunction-Associated Steatohepatitis (MASH). Prognosticating the risk of disease progression in MASLD and MASH has traditionally involved liver biopsy, a process that involves removing a tissue sample with a hollow needle and then examining the sample under a microscope to diagnose and stage disease. However, biopsy has many limitations. Additionally, drug development for MASLD and MASH has proceeded slowly in part due to a reliance on liver biopsy to determine drug efficacy.Recently, increasing evidence is suggesting that non-invasive options, for example, imaging examinations along with blood tests that assess likelihood of disease progression such as the Enhanced Liver Fibrosis (ELF) Test, may effectively reduce the need for the more invasive alternative. Key experts in MASLD and MASH share their perspectives about how clinical evidence supports a shift in the way patients with MASLD and MASH could be evaluated in clinical practice and in research.Host Matt Gee, Director of Collaborations and External Engagement at Siemens Healthineers, is joined by Prof. William Rosenberg, Deputy Director of the Institute for Liver and Digestive Health at University College London as well as Dr. Veronica Miller, Director of the Forum for Collaborative Research at the University of California, Berkeley School of Public Health; Dr. Arun Sanyal, Professor of Medicine, Physiology, and Molecular Pathology in the Division of Gastroenterology at Virginia Commonwealth University; and Dr. Michelle Long, International Medical Vice President of Metabolic Dysfunction-Associated Steatohepatitis at Novo Nordisk and Associate Professor in the Section of Gastroenterology and Hepatology at Boston University.What you'll learn in this episode:Liver biopsy creates several obstacles for patients and has limitationsDrug development faces challenges by the reliance on biopsy as a measure of treatment effectivenessNon-invasive tools may be suitable alternatives to liver biopsy both in clinical practice and in drug developmentConnect with Matt GeeLinkedIn Connect with Veronica MillerLinkedInConnect with William RosenbergLinkedInConnect with Michelle LongLinkedInConnect with Arun SanyalVCU.edu Hosted on Acast. See acast.com/privacy for more information.

David Wojahn grew up in St. Paul, Minnesota. He studied at the University of Minnesota and the University of Arizona. Ever since his first collection, Icehouse Lights, was chosen for the Yale Series of Younger Poets award in 1981, Wojahn has been one of American poetry's most thoughtful examiners of culture and memory. His work often investigates how history plays out in the lives of individuals, and poet Tom Sleigh says that his poems “meld the political and personal in a way that is unparalleled by any living American poet.”Wojahn's book World Tree (2011) received the Lenore Marshall Poetry Prize from the Academy of American Poets. His collection Interrogation Palace: New and Selected Poems 1982–2004 (2006), which Peter Campion called “superb” and “panoramic” in a review for Poetry, showcases Wojahn's formal range, the scope of his personal narratives, and his intense, imaginative monologues and character sketches, such as his sonnets on pop culture icons and rock-and-roll musicians in Mystery Train (1990). He is also celebrated for the emotional resonance of his poetry—the ability to, in the words of poet Jean Valentine, “follow … tragedy to its grave depths, with dignity and unsparingness, and egolessness.”In addition to his books of poetry, Wojahn is the author of From the Valley of Making: Essays on the Craft of Poetry (2015) and Strange Good Fortune (2001), a collection of essays on contemporary poetry. He coedited A Profile of Twentieth Century American Poetry (1991), and edited a posthumous collection of his wife Lynda Hull's poetry, The Only World (1995).Wojahn has received fellowships from the Guggenheim Foundation, the National Endowment for the Arts, the Fine Arts Work Center in Provincetown, the Illinois Arts Council, and the Indiana Arts Commission. He teaches poetry at Virginia Commonwealth University and in the low residency MFA in Writing program at the Vermont College of Fine Arts.-bio via Poetry Foundation This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit dailypoempod.substack.com/subscribe

Learning Objectives:By the end of this series, listeners should be able to discuss:The physiologic rationale supporting the use of airway pressure release ventilation (APRV) in ARDS. The patient populations most likely to benefit from APRV.Key published evidence that informs our use of APRV in critical care.An expert approach to managing a patient with APRV.Next steps in research that will direct our understanding of the use of APRV in pediatric critical care.About our Guest: Dr. Palen Mallory is an assistant professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. She completed medical school at Virginia Commonwealth University, a pediatric residency at Emory University, and a critical care fellowship at Vanderbilt University. She is interested in respiratory care research, including ECMO, respiratory failure, and ARDS.Selected References:Mallory, P., & Cheifetz, I. (2020). A comprehensive review of the use and understanding of airway pressure release ventilation. Expert Review of Respiratory Medicine, 14(3), 307–315. https://doi.org/10.1080/17476348.2020.1708719Frawley, P. M., & Habashi, N. M. (2004). Airway pressure release ventilation and pediatrics: Theory and practice. Critical Care Nursing Clinics of North America, 16(3 SPEC. ISS.), 337–348. https://doi.org/10.1016/J.CCELL.2004.04.003Fredericks, A. S., Bunker, M. P., Gliga, L. A., Ebeling, C. G., Ringqvist, J. R. B., Heravi, H., Manley, J., Valladares, J., & Romito, B. T. (2020). Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 14. https://doi.org/10.1177/1179548420903297APRV Guideline - EMCrit Project. (n.d.). Retrieved March 30, 2025, from https://emcrit.org/squirt/aprv/Andrews P, Shiber J, Madden M, Nieman GF, Camporota L, Habashi NM. Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal. Front Physiol. 2022 Jul 25;13:928562. doi: 10.3389/fphys.2022.928562. PMID: 35957Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Spontaneous intracranial hypotension reflects a disruption of the normal continuous production, circulation, and reabsorption of CSF. Diagnosis requires the recognition of common and uncommon presentations, careful selection and scrutiny of brain and spine imaging, and, frequently, referral to specialist centers.  In this episode, Gordon Smith, MD, FAAN speaks with Jill C. Rau, MD, PhD, author of the article “Clinical Features and Diagnosis of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Rau is an assistant professor of clinical neurology at the University of Arizona, School of Medicine-Phoenix in Phoenix, Arizona. Additional Resources Read the article: continuumjournal.com Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full episode transcript available here Interview with Jill Rau, MD Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: This is Dr Gordon Smith. Today I'm interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension, which she wrote with Dr Jeremy Cutsworth-Gregory from the Mayo Clinic. This article appears in the 2025 Continuum issue on disorders of CSF dynamics. I'm really excited to welcome you to the Continuum podcast. Maybe you can start by just telling our listeners a little bit about yourself? Dr Rau: Hi, thanks for having me. I'm really honored to be here, and I really enjoyed writing the paper with Dr Cutsforth-Gregory. I hope you guys enjoy it. I am the director of headache medicine at the Baba Bay Neuroscience Institute at Honor Health in Scottsdale, Arizona. I'm also currently the chair of the special interest group in CSF Dynamics at the American Headache Society, and I've had a special interest in this field since I first watched Dr Linda Gray speak at a conference where she talked about spinal CSF leaks and their different presentations. And they were so different than what I had been taught in residency. They're not just the post-LP headache. They have such a wide variety of presentations and how devastating they can be, and how much impact there is on someone's life when you find it and fix it. And I've been super interested in the field and involved in research since that time. And, yeah. Love it. Dr Smith: Well, thanks for sharing your story. And as I reflected on our conversation ahead of time and have been thinking about this issue… this is a cool topic, and every time I read one of these manuscripts and have the opportunity to speak with one of the authors, I learn a ton, because this was something that wasn't even on the radar when I trained back in the 1800's. So, really looking forward to the conversation. I wonder if you could really briefly just summarize or remind for everyone the normal physiology about CSF dynamics, you know, production, absorption, and so forth? Dr Rau: So, the CSF is the fluid that surrounds the brain and the spinal cord, and it's contained by the dura, which is like a canvas or a sac that covers that whole brain and spinal cord. And within the ventricles of the brain, the choroid plexus produce CSF. It's constantly producing and then being reabsorbed by the arachnoid granulations and pushed into the venous space, the cerebral sinuses, venous sinuses. And also some absorption and push into the lymphatics that we've just learned about in the past year. This is kind of new data coming out, so always learning more and more about CSF, but we know that it bathes the brain and the spinal cord, helps keep some buoyancy of the brain as well as pushing nutrients in and pulling out metabolic waste. And it sort of keeps the brain in the state of homeostasis that's happy. And so, when there's a disruption of that flow and the amount of fluid there, that disrupts that, that can cause lots of different symptoms and problems for people. Dr Smith: One of the many new things I learned is that even the name of this---spontaneous intracranial hypotension---is misleading. And I think this is clinically relevant, as we'll probably get to in a moment, but can you talk a little bit about this? Is this really like a pressure disorder or a volume disorder? Dr Rau: Yeah. It's almost certainly a volume disorder. We do see in some people that they have low pressure, and it's still part of the diagnostic criteria. But it's there because if you have a low pressure, if you measure an opening pressure and it's below six, if you're measuring it in the spine in the right place, then you have indication that there's low volume. But there's over 50% of people's opening pressure who have a spinal CSF leak, have all the symptoms and can be fixed. So, they have normal pressure in 50% of the people. So, it is an inaccurate term, hypotension, but it was originally discovered because of the thought that it was a low-pressure situation. Some of the findings would suggest low pressure, but ultimately, we are pretty sure it's a low-volume condition. Dr Smith: Another new thing that I learned that really blew me away is how bad this can be. I did a podcast with Mark Burish about cluster, and I was reminded many cluster patients are pushed to the point of suicidal ideation or committing suicide by the severity of pain. And this sounds like for many patients it's equally severe. Can you maybe paint a picture for our listeners why this is so clinically important? Dr Rau: A large number of people, even people who are known to have leaks because they've had them before or they've releaked, they have a lot of brain fog and cognitive impairment. They often have severe headaches when they're upright. So, orthostatic headache is probably the number one most common symptom, and those headaches are one of the worst headaches out there. When people stand up, their fluid is not supporting the brain and there's an intense amount of pain. And so, they spend a large portion of their lives horizontal. And there's associated symptoms with that, it's not just headache pain and brain fog. There's neck pain. There's often subsequent disorders that accompany this, like partial orthostatic tachycardia syndrome. We don't know if that's because of deconditioning or an actual sequela of the disease, but it's a frequent comorbidity. We have patients that have extreme dizziness with their symptoms, but many patients are limited to hours, if that, upright per day, combined, total. And so they live their lives, often, just in the dark, lots of photophobia, sensitive to the light, really unable to function. It's also very hard to find and so underrecognized that a lot of patients, especially if they don't have that really clinical symptom of orthostatic headache. So, it's often missed. So, they're just debilitated. You know, treatments don't work because it's not a migraine and it's not a typical headache. It's a mechanical issue as well as a metabolic issue and not found, not a lot helps it. Dr Smith: So, you know, I have always thought about this as really primarily an orthostatic symptom. I wonder if you can talk about the complexity of this; in particular, kind of how this evolves over time, because it's not quite that simple. And maybe in doing so, you can give our listeners some pearls on when they should be thinking about this disorder? Dr Rau: A large portion of people do have headache with spinal CSF leak, in particular, spontaneous intracranial hypertension- hypotension, excuse me. And that's something to be thought about, is that there are spontaneous conditions where people have either rupture of the dural sac, or an erosion of the dural sac, or a development of a connection between the dura and the venous system. And that is taking away or allowing CSF to escape. In these instances that patients have spontaneous, there may be a different presentation than if they have, like, a postdural puncture or a chronic traumatic or iatrogenic leak. And we're not sure of that yet, but we're looking into that. Still, the largest presentation is headache, and orthostatic headache is very dominant in the headache realm. But over time, patients' brains can compensate for that lack of CSF and start overproducing---or at least we think that's probably what's happening. And you may see a reduction in the orthostatic symptoms over time, and you may see an improvement in the radiographic findings. So, there are some interesting papers that have been published that look at these changes over time, and we do see that sometimes within that first three to four months; this is the most common time to see that change. Other patients may worsen. You may actually see someone going from looking sort of normal radiographically to developing more of a SIH-type of picture on the brain. And so it's not predictable which patients have gone from orthostatic to improvement or the other way around, both radiographically and clinically. So, it can be quite difficult to tell. So, for me, if I have a patient that comes to me and they're struggling with headache… if it's orthostatic, very clearly orthostatic: I lay down, I get considerably better or my headache completely goes away. And then when I stand up, it comes on relatively quickly, within an hour. And sometimes it's a worsening-throughout-the-day type of thing, it's lowest in the morning and it worsens throughout the day. These are the times that it's most obvious to think about CSF leak. Especially if that headache onset relatively suddenly, if it onset after a small trauma. Like I've had patients that say, you know, I was doing yoga and I did some twists and I felt kind of a pop. And then I've had this headache that is horrible when I'm upright but is better when I lay down ever since, you know, since that time. That's kind of a very classic presentation of spinal CSF leak or spontaneous intracranial hypotension. Maybe a less common presentation would be someone who comes to you, they've had a persistent headache for a couple years, they kind of remember it started in March of a couple years ago, but they don't know. Maybe it's, you know, it's a little better when they lay down. It may be a little worse when they're up moving around, but so is migraine, and it's a migrainous headache. But they've tried every migraine drug you can think of. Nothing is responding, nothing helps. I'm always looking at patients who are new daily, persistent headaches and patients who aren't responding to meds even if it's not new daily, but they have just barely any response. I will always go back and examine their brain imaging and get full spine to make sure I'm not missing. And you can never be 100% sure, but it's always good to consider those patients to the best of your ability, if that- have that in the back of your mind. Dr Smith: So obviously, goes without saying, this is something people need to have on their radar and think about. And then we'll talk more about diagnostic tools here in a second. But how common is this? If you're a headache doc, you see a lot of patients who have intractable headaches. And how often do you see this in your headache practice? Now you're- this is your thing, so probably a little more than others, but, you know, how common will someone who sees a lot of headache encounter these patients? Dr Rau: If you see a lot of headache, I mean, currently the thought is it's about 5 in 100,000. That was from a study before we were finding CSF venous fistulas. I think a lot of us think it's more common than that, but it's not super common. We don't have good estimates, but I would guess between 5 and 10 for 100,000 persons, not “persons who come to a tertiary headache clinic with intractable headaches”. So, it's hard to gauge how frequent it is, but I would say it's considerably more frequent than we currently think it is. There's still a group of people with orthostatic headaches that we can't find leaks on; that, once you treat other things that can cause or look for other things that can cause orthostatic headaches. So, there may be even still a pathophysiology out there that is still a leak type. Before 2014, we didn't even know about CSF venous fistulas. And now here we are; like, 50% of them are CSF venous fistulas. So, you know, we're still in a huge learning curve right now. Dr Smith: So, I definitely want to talk about the fistulas in a second. But before moving on, one of the things that I found really interesting is the wide spectrum of clinical phenotype. And we obviously don't have a lot of time to get into all of these different ones, but the one that I was hoping you might talk about---and there's a really great case, and you're on bunch of great case, a great case of this---is brain sagging dementia, not a term I've used before. Can you really briefly just tell our listeners about that, because that's a really interesting story and a great case in your article? Dr Rau: Yeah. So, brain sag dementia is a… almost like an extreme version of a spontaneous intracranial hypotension. Where there is clear brain sag in the imaging---so that's helpful---but the patients present kind of like a frontotemporal dementia. And when this was first started to being determined, you could turn the patient into Trendelenburg, and sometimes they would improve. There are some practitioners that have introduced fluid into the thecal sac and had temporary improvement. Patching has improvement, then they leak again, sometimes  not. But the clinical changes with this have been pretty tremendous to be able to identify that that's a real thing. And in some cases, out of Cedars Sinai, you know, who does a lot of the best research in this, they've had lots of cases where they can't find the leak, but there's clear brain sag that fits with our clinical picture of CSF leaks. So, we're on a learning curve. But yeah, this- they really present. They have disinhibition and cognitive impairment that is very similar to frontotemporal dementia. Dr Smith: Well, so let's talk about what causes this. You mentioned CSF venous fistulas. I mean, that was reported now just over a decade ago, it's pretty amazing. That accounts for about half of cases, if I understand correctly. What are the other causes? And then we'll talk more about therapy in a minute, but what causes this? Dr Rau: So, within the realm of spontaneous, you know, we say it's spontaneous. But the spontaneous cases we account for, they can be tears in the dura, which are usually sort of lateral tears in the dura. They can be little places that rubbed a hole, often on an osteophyte from the spine. They can come from these spinal diverticuli. So, I always describe it to my patients like those balls that have mesh and squishy, and you squeeze them in the- through the mesh, there's the extra little bubbling out. If you think of like the dura bubbling, out in some cases, through the framing of the spine, right where the spinal nerve roots come out, they should poke out like wires from the dura. But in many cases they poke out with this extra dura surrounding them, and we call that spinal diverticuli. And if you imagine like the weakening of where you squeeze that, you know, balloon through your fingers, in those locations, that's a very common place to find a CSF leak, and you can imagine that the integrity of the dura there may be less than it would be if it were not being expanded in that direction. And that's often the most common place we see these CSF venous fistulas. So, you can get minor traumas; like I said, it can be spontaneous, like someone just develops a leak one day. It can be rubbed off, and it can be a development of a connection between the dura and the venous system. There are also iatrogenic causes, but we don't consider them spontaneous. But when you're considering your patients for spontaneous cases, you should consider if they've ever had chronic---even long, long time ago---had any spinal implementation, procedures near the spine, spinal injections, LPs in the past, and especially women who've had epidurals in pregnancy. Dr Smith: All right, so we see a patient, positional severe headache, who meets the clinical criteria. Next step, MRI scan? Dr Rau: Yeah. So, the first thing is always to get the brain MRI with and without contrast. Most places will have a SIH or a spinal CSF leak protocol, but you should get contrast because one of the most pathognomonic findings on brain MRI is that smooth diffuse dural enhancement. And that's a really fantastic thing when you find it, because it's kind of a slam dunk. If you find it, then you will see other findings. It almost never exists alone. But if you see that, it's pretty much a spinal CSF leak. But you're also looking for subdural collections, any indication of brain sag. We do have these new algorithms that have come out in the past couple of years that are helpful. They're not exclusionary---you can have negative findings on the brain and still have spinal CSF leak---but the brain MRI is extremely helpful. If it's positive for the findings, it really does help you nudge you in the direction of further investigations and treatments. Dr Smith: And what about those further investigations and treatments, right? So, you see that there's findings consistent with low pressure, and I guess I should say low intracranial CSF volume. Be that as it may, what's the next step after that? Dr Rau: Depends on where you are and what you can do. I almost always will get a full spine MRI: so, C spine, T spine, and L spine separately. Not, you know, we don't want it all in one picture, because we want to get the full view. And you want to get that with at least T2 highly- heavily T2 weighted with fat saturation in at least the sagittal and axial planes. It's really helpful if you can get it in the coronal planes, but we have to have- often have good talks with your radiologist to get the coronal plane. I spoke about the spinal diverticuli earlier, and I want to clarify a little bit of something. The coronal image will show those really nicely. It's interesting, but 44% of people have those. So just having the spinal diverticuli does not indicate that you have a leak. But if you have a lot of those, there may be more likelihood of having leak than if you don't have any of those. So, I will get all of those and I will look at them myself, but I've been looking at them myself for a long time. But a lot of radiologists in community hospitals, especially not- nonneuroradiologists, but even neuroradiologists, this isn't something that's that everybody's been educated about, and we've been learning so much about it so rapidly in the past ten years. It's not easy to do and it's often missed. And if it's not protocoled properly, the fat saturation's not there, it's very hard to see… you can have a leak and not see it. Even the best people, like- it's not always something that's visible. And these CSF venous fistulas that we talked about are never visible on normal MRI imaging. Nonetheless, I will run those because if I can find a leak---and 90% of the ones that are found on MRI imaging are in the thoracic spine. So that's where I spend the most of my time looking. But if you find it, that's another thing to take to your team to say, hey, look, here it is, let's try and do this, or, let's try and do that, or, I've got more evidence. And there are other findings on the spine; not just the leak, but other findings, sometimes, you can see on spine that maybe help you push you towards, yes, this is probably a leak versus not. Dr Smith: So, your article has a lot of great examples and detail about kind of advanced imaging to, like, find the fistula and what not. I guess I'm thinking most of our listeners are probably practicing in a location where they don't have a team that really focuses on that. So, let's say we do the imaging of the spine and you don't find a clear cause. Is the next step to just do a blood patch? Do you send them to someone like you? What's the practical next step? Dr Rau: Yeah, if your- regardless of whether you find a leak or not, if your clinical acumen is such that you think this patient has a leak or I've treated them for everything else and it's not working and I have at least a high enough suspicion that I think the risk of getting a patch is lower than the benefit that if they got a patch and it worked, I do send my patients for non-directed blood patches, because it currently does take a long time to get them to a center that can do CT myelograms or any kind of advanced imaging to look for sort of a CSF venous fistula or to get treated outside of a nondirected patch. You know, sometimes nondirected patches are beneficial for patients, and there's some good papers out there that sort of explain the low risks of doing these if done properly versus the extreme benefit for patients when it works. And, I mean, I can't tell you how many people come in and tell me how their lives are changed because they finally got a blood patch. And sometimes it works. And it's life-changing for those people. You know, they go back to work. They can interact with their kids again. Before, they didn't know what was wrong, just had this headache that started. So it's worth doing if you have a strong clinical suspicion. Dr Smith: Yeah. I mean, that was great. And, you know, to go back to where we began, this is severe. It's something like 60% of patients with this problem have thought about suicide, right? And you take this patient and cure the problem. I feel really empowered having read the article and talked to you today. And so, I'm ready to go out and look for this. Thank you so much for a really engaging conversation. This has been terrific. Dr Rau: Thank you. I appreciate it. I enjoyed being here. Dr Smith: Again, today I've been interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension---which I guess I should say hypovolemia after having talked to you---which she wrote with Dr Jeremy Cutsworth-Gregory. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Please be sure to check out Continuum Audio episodes from this really interesting issue and other interesting issues. And thank you, our listeners, again for listening to us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In Episode 106 of The Waypoint Podcast, Dyke and Rebecca sit down with Dominic Chasse, campus minister at Virginia Commonwealth University for Christian Student Fellowship, for a conversation that is both heartfelt and inspiring. Dom shares his unique journey into campus ministry, highlighting meaningful connections with Waypoint along the way. He unpacks the critical importance of helping the next generation understand and embrace their identity in Christ and offers a timely challenge for leaders to prioritize soul care amidst the demands of ministry. Listeners will find this episode fun, thought-provoking, and deeply encouraging.Find out more about CST at VCUwww.cmov.org/csfvcu-1Remember you can always find us atwaypointchurchpartners.comFollow us atfacebook.com/WaypointChurchPartnersinstagram @waypointchurchpartnersThe Waypoint Podcast is hosted and produced by Dyke McCordhosted, produced, and edited by Rebecca HottIf you want to find out more about supporting Waypoint Church Plants head toiplantchurches.comRegister for future Waypoint Events or reach out to any of our Staff!

Dr. Joel Berg is joined by cariology expert Dr. Brian Novy for a discussion on all there's still to learn about dental caries. Dr. Novy delves into the importance for practitioners to understand the science of cariology, particularly when working with patients and families that may be opposed to traditional treatments, like fluoride. He also shares his personal path in evidence-based dentistry research and how this work has improved his approach to educating the future generation of dentists. Guest Bio: Often described as “The tenth dentist,” Dr. Brian B. Nový has faculty appointments at Virginia Commonwealth University and Harvard School of Dental Medicine. He served on the American Dental Association Council of Scientific Affairs from 2010-2014, and in 2016 was appointed the consumer representative to the United States Food & Drug Administration Dental Products Panel. His papers are published in various journals including the Journal of the American Dental Association, the Journal of Dental Research, the Journal of Evidence Based Dentistry, Dentistry Today, Inside Dentistry, Dental Economics, Compendium, the National Academies of Medicine, and the International Journal of Equity in HealthSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The discussion covered various current events and issues, beginning with the resignation of a CBS news chief, which was attributed to the network's handling of Trump-related controversies and a perceived decline in journalistic freedom. Jeffrey and Brian criticized the editing practices that could misrepresent facts and examined the financial challenges CBS faces amid ongoing lawsuits. They also touched on Harvard University's decision to self-fund its research due to funding cuts from the Trump administration, questioning the rationale behind federal funding for wealthy private universities. The conversation shifted to political protests at Virginia Commonwealth University, where students and faculty expressed discontent over Republican Governor Youngkin's selection as a keynote speaker. We voiced concerns about the lack of respect for differing political views among students. They also discussed Hillary Clinton's remarks regarding the Republican Party and the historical context of racism and sexism in politics. Additionally, they reflected on the reinstatement of Pete Rose and Shoeless Joe Jackson to MLB eligibility, questioning the motivations behind these decisions.

 A tiny bite from a tiny tick can trigger a complex disease which speaks to some huge problems with our healthcare system. In this episode, we explain the biology, controversy, and cultural blind spots around Lyme disease, a condition that reflects much more than just a bacterial infection. It's also a mirror for our most urgent public health issues: inequality, misinformation, climate change, and the growing mistrust of science. We speak with two world-class experts: • Dr. John Aucott: Director of the Johns Hopkins Lyme Disease Clinical Research Center and leading voice on post-treatment Lyme disease syndrome (PTLDS) • Dr. Richard Marconi: Professor of microbiology and immunology at Virginia Commonwealth University, and a pioneering scientist behind next-generation Lyme vaccines Together, we explore: • Why Lyme disease symptoms can linger long after treatment • What makes Lyme so neurologically disruptive (and so hard to diagnose) • How climate change, suburban development, and racial disparities intersect with the rise of tick-borne illness • The dangers of alternative medicine grifters preying on desperate patients • The truth about the original Lyme vaccine, and what's coming next... We also share practical prevention tips and discuss how Lyme disease is shaping the future of infectious disease research, diagnostics, and brain health. This is... Your Brain On Lyme Disease. ‘Your Brain On' is hosted by neurologists, scientists, and public health advocates Ayesha and Dean Sherzai. SUPPORTED BY: NEURO World. Help your brain thrive, now and into the future: https://neuro.world/  ‘Your Brain On... Lyme Disease' • SEASON 5 • EPISODE 4 ——— FOLLOW US Instagram: https://www.instagram.com/thebraindocs YouTube: https://www.youtube.com/thebraindocs Website: https://thebraindocs.com/

A reversible liver condition is the fastest growing cause of liver transplantation in Western countries: Metabolic dysfunction-associated steatotic liver disease—or MASLD—affects patients worldwide. It's characterized by excessive fat accumulation in the liver and can progress into more severe forms of liver disease, potentially resulting in fibrosis, cirrhosis and liver failure.Risk factors for developing liver disease include obesity, insulin resistance, type 2 diabetes, and metabolic syndrome. Genetics, unhealthy dietary habits, and a sedentary lifestyle can also play significant roles in its development. Diagnosis typically involves imaging examinations along with blood tests that assess liver function and rule out other causes of liver disease.Disease management focuses on lifestyle modifications such as diet and exercise, though new medications are now being prescribed to slow and potentially reverse this condition. Regular monitoring of disease progression is also crucial for successful treatment.In this episode, experts in the field of liver disease address the progress happening in the recognition, diagnosis and treatment of the disease. Host Matt Gee, Director of Collaborations and External Engagement at Siemens Healthineers, is joined by Dr. Michelle Long, International Medical Vice President of Metabolic Dysfunction-Associated Steatohepatitis at Novo Nordisk and Director of Clinical Research for the Section of Gastroenterology and Hepatology at Boston University; Dr. Arun Sanyal, Professor of Medicine, Physiology, and Molecular Pathology in the Division of Gastroenterology at Virginia Commonwealth University; and Michael Betel, President and Founder of the Fatty Liver Alliance.What you'll learn in this episode:One of the biggest obstacles to diagnosing MASLD before it progresses stems from the lack of visibility and awareness of the diseaseMASLD is a reversible disease when caught in timeMASLD is more complex than a patient's diet or lifestyle—metabolic dysfunction plays a role Non-invasive testing has become an important tool in advancing patient careConnect with Matt GeeLinkedIn Connect with Michelle LongLinkedInConnect with Arun SanyalVCU.eduConnect with Michael BetelLinkedIn Hosted on Acast. See acast.com/privacy for more information.

Superpowers for Good should not be considered investment advice. Seek counsel before making investment decisions. When you purchase an item, launch a campaign or create an investment account after clicking a link here, we may earn a fee. Engage to support our work.Watch the show on television by downloading the e360tv channel app to your Roku, AppleTV or AmazonFireTV. You can also see it on YouTube.Devin: What is your superpower?Todd: I careWhat if a favorite drink could change the world? That's the ingenious idea behind Chef Todd Manley's Mutiny Island Vodka. By using breadfruit—a tropical superfood—as its primary ingredient, Mutiny Island Vodka addresses two pressing global challenges: poverty and climate change.Todd, a chef turned entrepreneur, explained how breadfruit transforms lives in tropical regions. “One breadfruit tree will feed a family of four for life,” he noted, emphasizing its nutritional and economic potential. In regions plagued by food insecurity and poverty, breadfruit provides not only sustenance but also economic opportunities. Farmers can grow breadfruit to feed their families, sell it locally, or export products like breadfruit flour. Mutiny Island Vodka incentivizes the planting of these trees, creating a sustainable cycle of economic growth and environmental restoration.Breadfruit's environmental benefits are equally impressive. Todd highlighted, “Breadfruit trees sequester hundreds of tons of carbon dioxide out of the atmosphere and they're long living.” Unlike annual crops like wheat or corn that require replanting, breadfruit trees thrive for decades, continuously bearing fruit while pulling carbon dioxide from the air.Mutiny Island Vodka, the world's first vodka made from breadfruit, is more than just a spirit—it's a movement. The company's partnerships with organizations like the Trees That Feed Foundation amplify its impact. For every bottle sold or investment made, a breadfruit tree is planted in a region that needs it most. This initiative not only addresses food security but also serves as a scalable climate solution.Todd and his team are currently raising funds through a regulation crowdfunding campaign on Start Engine. This capital will help expand production and distribution, bringing Mutiny Island Vodka to more people and creating even greater impact. Todd shared his ambitious vision: “We are set on becoming a household name...better cocktails, better planet.”Todd's innovative approach and commitment to making a difference demonstrate how business can be a force for good. Mutiny Island Vodka isn't just a drink—it's a tangible example of how ingenuity and purpose can tackle global challenges. Those interested in supporting this mission can explore the opportunity to invest and join the effort to fight poverty and save the planet, one sip at a time.tl;dr:Mutiny Island Vodka uses breadfruit to fight poverty and climate change while producing award-winning spirits.Breadfruit trees provide food security, economic opportunities, and carbon sequestration in tropical regions.Mutiny Island Vodka is raising funds via regulation crowdfunding to expand production and impact.Todd's superpower, caring, drives his work and fosters a network of trust and collaboration.During the pandemic, Mutiny produced hand sanitizer for frontline workers, showcasing care and ingenuity.How to Develop Caring As a SuperpowerTodd's superpower is his genuine care for others. He explained, “I think my number one superpower is I care.” This deep empathy fuels his work and draws like-minded people into his orbit, fostering a network of trust and collaboration. Todd elaborated, “When you find someone else that has that same superpower, you tend to really latch on to them...having that is just incredible.”Illustrative Story:During the pandemic, Todd noticed that the Virgin Islands had no hand sanitizer for hospitals, police, or frontline workers. Leveraging Mutiny Island Vodka's resources, his team began producing sanitizer using breadfruit-derived alcohol. This act of care not only met the community's critical needs but also helped sustain the business during a challenging time.Tips for Developing the Superpower:Practice listening actively by using “two ears and one mouth” to understand others better.Reframe negative thoughts or words into positive, solution-oriented language.Cultivate empathy by considering what others might be experiencing.Surround yourself with like-minded, caring individuals to foster collaboration and trust.By following Todd's example and advice, you can make caring a skill. With practice and effort, you could make it a superpower that enables you to do more good in the world.Remember, however, that research into success suggests that building on your own superpowers is more important than creating new ones or overcoming weaknesses. You do you!Guest ProfileChef Todd Manley (he/him):CEO, Mutiny Island VodkaAbout Mutiny Island Vodka: Our company was founded to produce the World's first, Island Vodka, hand crafted with breadfruit, Mutiny Island Vodka. The business has grown to encompass a production distillery, restaurant, tourist attraction, event venue, and of course Mutiny Island Vodka as a brand on its own. Mutiny Island Vodka is being featured on the shelves and menus of some notable partners such as:  The Seminole Hard Rock Hotel and Casino, Applebee's Franchisees, American Airlines Lounges, Virgin Voyages, and more. The partners align with the sustainability and altruistic components of the brand, ie; breadfruit!Website: mutinyislandvodka.comCompany Facebook Page: facebook.com/search/top?q=mutiny%20island%20vodkaOther URL: startengine.com/offering/mutinyislandvodkaBiographical Information: Todd has been honored to receive numerous awards from "Chef of the Year" to multiple recognitions of his restaurants as the "best" in several categories, and nominated for an Elby Award in 2012 as a restaurant visionary. He has largely been self-employed his entire life, loving the challenge of taking ideas out of thin air and turning them into tangible, profitable realizations. He is a graduate and former graduate school student of Virginia Commonwealth University.Since making the USVI his home, he has opened 5 successful businesses in a short four years, continually reinvesting in Christiansted and the USVI effectively helping pull up the town by reinvigorating interest in Christiansted during an economically gloomy period of time. In 2015, the community honored him through the Chamber of Commerce awarding him "Business Man of the Year.” The same year he received the U.S. Congressional Award for contributions to community and betterment of society for his achievements and helping the community of St. Croix. His commitment to better the global community through his work with breadfruit and the breadfruit community resulted in being honored at the Global Breadfruit Summit in Hawaii in both 2018 and 2022 for contributions to the community and innovation. Mutiny Island Vodka also received an endorsement from a charity, Trees That Feed Foundation for using breadfruit as a substrate incentivizing the planting of breadfruit trees.When he has free time, he can be found with his wife from Dominica, playing guitar, scuba diving, or on a beach! Todd works approximately 70-80 hours per week in his roles with Mutiny Island Vodka and approximately 1/2 hour per week as a founding Member of Smorrebrod, LLC.Personal Facebook Profile: facebook.com/todd.manley.182Instagram Handle: @cheftoddmutinySupport Our SponsorsOur generous sponsors make our work possible, serving impact investors, social entrepreneurs, community builders and diverse founders. Today's advertisers include FundingHope, SuperCrowd25, and Crowdfunding Made Simple. Learn more about advertising with us here.Max-Impact MembersThe following Max-Impact Members provide valuable financial support:Carol Fineagan, Independent Consultant | Lory Moore, Lory Moore Law | Marcia Brinton, High Desert Gear | Paul Lovejoy, Stakeholder Enterprise | Pearl Wright, Global Changemaker | Ralf Mandt, Next Pitch | Scott Thorpe, Philanthropist | Matthew Mead, Hempitecture | Michael Pratt, Qnetic | Sharon Samjitsingh, Health Care Originals | Add Your Name HereUpcoming SuperCrowd Event CalendarIf a location is not noted, the events below are virtual.Impact Cherub Club Meeting hosted by The Super Crowd, Inc., a public benefit corporation, on May 20, 2025, at 1:00 PM Eastern. Each month, the Club meets to review new offerings for investment consideration and to conduct due diligence on previously screened deals. To join the Impact Cherub Club, become an Impact Member of the SuperCrowd.SuperCrowdHour, May 21, 2025, at 1:00 PM Eastern. Devin Thorpe, Champion of Social Good and CEO of The Super Crowd, Inc., will lead a session on "The Secret to Higher Investment Returns via Impact Crowdfunding." He'll share powerful strategies and real-world examples that show how aligning your investments with your values can lead to strong financial and social returns. If you're an investor looking to maximize impact or curious about the growing world of impact crowdfunding, this is a session you won't want to miss! Don't miss it!SuperCrowd25, August 21st and 22nd: This two-day virtual event is an annual tradition but with big upgrades for 2025! We'll be streaming live across the web and on TV via e360tv. Soon, we'll open a process for nominating speakers. Check back!Community Event CalendarSuccessful Funding with Karl Dakin, Tuesdays at 10:00 AM ET - Click on Events.Crowdfunding Addict: Lessons Learned from a Year of Daily Investments, Wednesday, May 14, 2025, at 2:00 PM ET.Regulated Investment Crowdfunding Summit 2025, Crowdfunding Professional Association, Washington DC, October 21-22, 2025.Call for community action:Please show your support for a tax credit for investments made via Regulation Crowdfunding, benefiting both the investors and the small businesses that receive the investments. Learn more here.If you would like to submit an event for us to share with the 9,000+ changemakers, investors and entrepreneurs who are members of the SuperCrowd, click here.We use AI to help us write compelling recaps of each episode. Get full access to Superpowers for Good at www.superpowers4good.com/subscribe

VPM higher education reporter Megan Pauly speaks to former staff members of Virginia Commonwealth University's Division of Inclusive Excellence.     In the podcast: VPM News reporter Megan Pauly speaks to former staff of VCU's shuttered diversity office. 

Hall of Mirrors (Pegasus Crime 2025) was selected as a New York Times Crime Novel of the Year. It opens with a fire – it's May 1954 and Lionel Kane is watching his apartment go up in flames with his lover and writing partner Roger Raymond trapped inside. The police are sure that it's a suicide. A couple of months earlier, Judy and Philippa attend a lecture by Ray Kane, one of their favorite mystery authors, and help him when he starts to look unwell. He's a little off, newly fired from his State Department job because of Senator Joseph McCarthy's purge of communists and homosexuals. A few months earlier, with hopes that he'd write about it, Judy and Philippa sent Ray Kane an anonymous packet of details about Adrian Bogdan, the spy and serial killer they'd been hunting for years, but they don't know that Adrian was responsible for Ray Kane's firing. After the lecture, they learn that “Ray Kane” is the pen name for Roger and Lionel, and Roger is the author's public face because Lionel is Black. Lionel has two strikes against him; gay and Black, and Judy also has a few challenges; she's mixed race, also gay, she has a personal connection to the serial killer, and the FBI is trying to stop her from learning the truth. John Copenhaver's debut novel, Dodging and Burning, won the 2019 Macavity Award for Best First Mystery, and The Savage Kind earned the 2021 Lambda Literary Award for Best LGBTQ Mystery. A passionate advocate for queer voices in crime fiction, Copenhaver is a founding member of Queer Crime Writers and currently serves on the board of International Thriller Writers. He mentors aspiring writers in the Low-Residency MFA program at the University of Nebraska and teaches creative writing and literature at Virginia Commonwealth University. He lives in Richmond, Virginia, with his husband, artist Jeffery Paul Herrity. When he's not writing or teaching, he's watching movies—and listening to them. Copenhaver has a passion for film scores and a collection of rare scores he's been curating since high school. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/literature

Today's episode is a conversation with Autumn Dea. She shares her journey into editing, her early interest in storytelling, the transition from advertising to long-form editing, and her experiences working on the film BLEEDING LOVE which was directed by Emma Westenberg starring Ewan McGregor and Clara McGregor. We discuss the emotional aspects of editing, the importance of collaboration with directors, and the challenges faced in the editing process. Autumn Dea is a film, television, and commercial editor from Los Angeles, CA. Originally hailing from the Philadelphia, PA area, Dea graduated from Virginia Commonwealth University's School of the Arts, with a Bachelor of Arts degree in film and a double minor in media studies and psychology. Dea's unique editorial background has allowed her to work with various high-profile artists and actors, including Beyonce, Lizzo, Ewan McGregor, and Jay Duplass. Her most recent feature film BLEEDING LOVE, directed by Emma Westenberg and starring Ewan McGregor and Clara McGregor, world premiered at SXSW 2023. The film has already garnered industry praise and was chosen as one of the must-see films of the festival by Deadline's SXSW 2023 Hotlist. Her most recent documentary feature film, LOVE, LIZZO (HBO Max), directed by Doug Pray and starring Grammy Award-winning musician and vocalist Lizzo, premiered on HBO Max in November 2022. Previously, her feature film, SHITHOUSE (IFC), directed by Cooper Raiff, won the Grand Jury Award for Best Narrative Feature at SXSW 2020 and was named Vanity Fair's 10 Best Movies of 2020. Her work in television has also received accolades including an Emmy award for THE FUTURE OF AMERICA'S PAST (PBS), and inclusion in the Tribeca Film Festival for the documentary feature THE DEATH OF MY TWO FATHERS (PBS), directed by Sol Guy.  

Today the Pugs are pleased to welcome Ryan Lauterio of The Maker Institute of Richmond, Virginia onto the show! Ryan is an academic and artist who taught at Virginia Commonwealth University and is now the Chief Executive Officer of The Maker Institute. The mission of the Institute is to develop Gospel-gripped, theologically minded, adept culture makers who faithfully seek to glorify Christ in all things. The Pugs enjoyed a free ranging conversation about the arts generally speaking and the current state of arts education. Learn more about The Maker Institute: https://themakerinstitute.org/ The Builder documentary referenced: https://www.youtube.com/watch?v=Z74o1Ld5eUE Support the Pugcast on Patreon: https://www.patreon.com/thetheologypugcast?fbclid=IwAR17UHhfzjphO52C_kkZfursA_C784t0ldFix0wyB4fd-YOJpmOQ3dyqGf8

Today the Pugs are pleased to welcome Ryan Lauterio of The Maker Institute of Richmond, Virginia onto the show! Ryan is an academic and artist who taught at Virginia Commonwealth University and is now the Chief Executive Officer of The Maker Institute. The mission of the Institute is to develop Gospel-gripped, theologically minded, adept culture makers who faithfully seek to glorify Christ in all things. The Pugs enjoyed a free ranging conversation about the arts generally speaking and the current state of arts education.Learn more about The Maker Institute: https://themakerinstitute.org/The Builder documentary referenced: https://www.youtube.com/watch?v=Z74o1Ld5eUESupport the Pugcast on Patreon: https://www.patreon.com/thetheologypugcast?fbclid=IwAR17UHhfzjphO52C_kkZfursA_C784t0ldFix0wyB4fd-YOJpmOQ3dyqGf8

Today the Pugs are pleased to welcome Ryan Lauterio of The Maker Institute of Richmond, Virginia onto the show! Ryan is an academic and artist who taught at Virginia Commonwealth University and is now the Chief Executive Officer of The Maker Institute. The mission of the Institute is to develop Gospel-gripped, theologically minded, adept culture makers who faithfully seek to glorify Christ in all things. The Pugs enjoyed a free ranging conversation about the arts generally speaking and the current state of arts education. Learn more about The Maker Institute: https://themakerinstitute.org/ The Builder documentary referenced: https://www.youtube.com/watch?v=Z74o1Ld5eUE Support the Pugcast on Patreon: https://www.patreon.com/thetheologypugcast?fbclid=IwAR17UHhfzjphO52C_kkZfursA_C784t0ldFix0wyB4fd-YOJpmOQ3dyqGf8

Today the Pugs are pleased to welcome Ryan Lauterio of The Maker Institute of Richmond, Virginia onto the show! Ryan is an academic and artist who taught at Virginia Commonwealth University and is now the Chief Executive Officer of The Maker Institute. The mission of the Institute is to develop Gospel-gripped, theologically minded, adept culture makers who faithfully seek to glorify Christ in all things. The Pugs enjoyed a free ranging conversation about the arts generally speaking and the current state of arts education. Learn more about The Maker Institute: https://themakerinstitute.org/ The Builder documentary referenced: https://www.youtube.com/watch?v=Z74o1Ld5eUE Support the Pugcast on Patreon: https://www.patreon.com/thetheologypugcast?fbclid=IwAR17UHhfzjphO52C_kkZfursA_C784t0ldFix0wyB4fd-YOJpmOQ3dyqGf8

For episode 190 of The Fire These Times, Dr. Michael Paarlberg talks to Dana El Kurd about El Salvador's ‘state of exception' under Nayib Bukele, how Trump sees that as a model, the conditions of Salvadorian prisons and what happens to the Venezuelan and other refugees and migrants deported from the USA by Trump and the unaccountable state actors doing his bidding.Paarlberg is associate professor at Virginia Commonwealth University and non-resident fellow at the Institute for Policy Studies. He was previously on TFTT in August of 2024 (episode 164) to talk about how Bukele created a ‘Gang State' in El Salvador. As that was before Trump's election, it is a good primer into what is it about El Salvador today that makes it so appealing to the maga movement.The Fire These Times is a proud member of⁠ ⁠From The Periphery (FTP) Media Collective⁠⁠. Check out other projects in our media ecosystem: From The Periphery Podcast, The Mutual Aid Podcast⁠, ⁠Politically Depressed⁠, ⁠Obscuristan⁠, and ⁠Antidote Zine⁠.To get early access to our episodes as well as other perks (monthly hangout, movie club, exclusive content and so on) you can join our patreon at Patreon.com/fromtheperiphery For more:Dana El Kurd is on BlueskyMichael Paarlberg is on BlueskyThe Fire These Times is on Bluesky,⁠ IG⁠ and⁠ YouTube⁠ and has a⁠ ⁠website⁠⁠ ⁠⁠⁠From The Periphery is on⁠ ⁠Patreon⁠⁠, ⁠Bluesky⁠, ⁠⁠YouTube⁠⁠,⁠ Instagram⁠, and has a⁠ website⁠⁠Transcriptions: Transcriptions are done by⁠ Antidote Zine⁠ and will be published on⁠ The Fire These Times' transcript archive⁠.Credits: Dana El Kurd (host), Elia Ayoub (producer, episode designer), ⁠⁠Rap and Revenge⁠⁠⁠⁠⁠⁠ (Music), ⁠⁠Wenyi Geng⁠⁠⁠⁠⁠⁠ (TFTT theme design), ⁠⁠Hisham Rifai⁠⁠⁠⁠ (FTP theme design) and ⁠⁠Molly Crabapple⁠⁠⁠⁠⁠⁠⁠ (FTP team profile pics). 

The inflammatory and infectious optic neuropathies are a broad, heterogeneous, and common group of diseases producing visual loss. Although many now-distinct syndromes have been previously combined as “typical or atypical optic neuritis,” recent developments highlight the importance of precision terminology as well as an individualized evaluation and treatment approach. In this episode, Gordon Smith, MD, FAAN speaks with Eric Eggenberger, DO, MS, FAAN, author of the article “Optic Neuritis” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Eggenberger is a professor of ophthalmology, neurology, and neurosurgery at the Mayo Clinic in Jacksonville, Florida. Additional Resources Read the article: Optic Neuritis Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: This is Dr Gordon Smith. Today I'm interviewing someone who really needs no introduction, Dr Eric Eggenberger, about his article on optic neuritis, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Eric, welcome to the podcast, and maybe you can introduce yourself to our audience. Dr Eggenberger: Thank you. Thanks for having me. So, my name is Eric Eggenberger. I work at Mayo Clinic Florida, and I am involved exclusively in neuro-ophthalmology. Dr Smith: I just had the pleasure, Eric, of talking yesterday with Lindsey De Lott about non-optic neuritis causes of optic neuropathy. And so, I'm going to kind of reference a little bit what I learned yesterday. She was great. I wonder if you might begin by talking a little bit about nomenclature. You talk about the need for use of precise terminology in your article. And yesterday she taught me a lot about the risk of misdiagnosis and other causes of optic neuropathy, and the two seem related. So, I wonder if you can maybe lay the foundation for our conversation by talking about terminology? Dr Eggenberger: I think that's a great point. So, we are in an era now where, instead of lumping all these different diagnoses together, we have learned to split apart some of these clinical entities. And so, I think it's really important that we focus on precise terminology and recognize that all optic neuritis is not the same. And we have very different, distinct clinical pathways for these imaging pathways, treatment pathways, for these different types of optic neuritis, whether that's MS related, whether it's MOG related or aquaporin-4 related. Dr Smith: So, I wonder maybe we can begin by just, you know, giving our listeners wisdom, pearls, and pitfalls about, how do you recognize when someone with a suspected optic neuropathy has optic neuritis versus a noninflammatory optic neuropathy? Dr Eggenberger: So, that's a really important issue because there's a lot of clinical overlap in terms of exam findings. So, for instance, in any optic neuropathy, let's say it's unilateral, you typically are going to see decreases in acuity and field and color, and you're going to see a relative afferent pupillary defect. And then it's really the context that that occurs in that helps us distinguish different disease entities. So, with optic neuritis, typically you're going to have pain. And that's oftentimes going to be in the younger populations compared to some of the other common optic neuropathies we see, like ischemic optic neuropathy, for instance. Dr Smith: Right. So maybe we can talk a little bit about, kind of, your overall diagnostic approach, right? A lot of this is, of course, based on age and context, but young people get ischemic lesions and older people can have inflammatory lesions. So, what's your overall approach to the patient you just described? Let's say it's a forty-eight-year-old woman who comes to the emergency department with subacute unilateral vision loss and there's dyschromatopsia, APD, reduced acuity. And, you know, let's just say a fairly, you know, benign-looking fundoscopic exam. What do you do to evaluate that patient? Dr Eggenberger: In that particular context, I think we're looking at other contextual clues. Is there other vascular risk factors or other things to point you in one direction or the other? One of the important parts you mentioned was the fundus exam. So, we know with ischemic optic neuropathy, 100% of the time with AIOM, you're going to see disc edema. And so, in the context of that story, we want to confirm on our exam an optic neuropathy, and then we can kind of focus on the retrobulbar courses or different types of optic neuropathies. From an exam perspective, in that particular patient we'd be looking to measure the acuity, quantify that. And in the ER, you're not going to be able to do a perfect field, but you'll get some sense of the field and how much field loss there is. And then as you mentioned, the afferent pupillary defect is critical. And we're going to get a little bit of the historical features in terms of pain. With typical retrobulbar optic neuritis, most of those patients are going to experience some pain, and usually it's pain on eye movements. And those would be the clinical things to focus on. Other exposures the patient may or may not have had, any other concomitant conditions, would all help point you in different directions, perhaps, and then we're probably on towards imaging. Dr Smith: Yeah, maybe you can talk a little bit about that? What's the appropriate use of imaging? I mean, presumably the patients, like the one I just threw out there, are pretty much all going to get neuroimaging. What's your approach to that? How do you protocol the study? What should we be looking for? Dr Eggenberger: In our clinic, we would typically be ordering an MRI orbit and brain, and each of those has a specific purpose. The orbit is going to show us the extent of the optic neuropathy. So, we're particularly looking for a longitudinally extensive optic nerve lesion or more than half of the optic nerve involved. And most patients acutely, if it isn't an “itis" situation, we'll see enhancement. And then the MR brain is going to be useful for looking for other evidence of demyelination within the central nervous system. We may at some point get down to doing an MR cord, but I think acutely it's going to be brain and orbit that most of our patients are getting. Dr Smith: Let's say that we did the scan and, sure enough, there's sort of a shorter segment, so less than half the length of the nerve region of enhancement. What's the rest of your diagnostic evaluation look like for that patient? Dr Eggenberger: So, in that particular case, we would look at the remainder of the brain. So, we're looking for other evidence of demyelination and any other contextual clues, systemically that would point you one direction or another. But with a shorter segment involved, one of the more common things we might encounter would be multiple sclerosis-related optic neuritis. Dr Smith: Would you look for aquaporin-4 and MOG in a patient with what appears to be an isolated, uncomplicated short segment optic neuritis? Dr Eggenberger: So, I think it really depends a bit on the context. I would never fault anybody for looking at MOG or an aquaporin-4 in that context because those are really treatment-altering diagnoses, but the yield in this particular case with a short segment involved and depending on the acuity and other features is probably going to be pretty low. Dr Smith: I really liked as an aside- I wasn't going to go there next, but you kind of got me thinking about it, you have a really nice section in your article. Which, all of it's great, but talking about how to manage low titer MOG antibodies. I wonder if you could talk about that because I think that's a lesson, maybe, that is transferable to a lot of other testing that we do. in terms of pre-prior probability and titer and so forth. Dr Eggenberger: Yeah, that's really an important point. So, we've seen this come up a number of times where the MOG antibody is a very good test, but in low titer it has a relatively low positive predictive value, perhaps 50%. In those cases, particularly without a classic clinical context, you have to be extremely alert for some other diagnosis that could mimic what you think is inflammatory demyelinating optic neuritis, but in fact is infectious or some other cause. Dr Smith: Yeah, super, super important and helpful. In terms of aquaporin-4, how does that compare in terms of predictive values, lower titer positive results? Dr Eggenberger: So aquaporin-4, the test has a very high specificity. So, it's quite useful if positive. You have to keep in mind there can be some false negatives, but the test otherwise is quite specific. And that is a diagnosis, you know, we never want to miss. It's a vicious disease. It tends to be a blinding disease, particularly without treatment. Bad things happen when we miss that, and we want to get on that diagnosis early and do pretty aggressive early and prophylactic treatment. Dr Smith: Your article covers not only the common causes of optic neuritis and, you know, MS, isolated optic neuritis, MOGAD NMO, you talk about a bunch of other things. I wonder, in this patient that we've been discussing, in the absence of any other historical information that seems relevant---or maybe you can define what would seem relevant---would you do other evaluation in that individual, other serologic evaluation and so forth, just in terms of diagnosis? Dr Eggenberger: In that particular case, without other red flags, I don't think I would initially. And follow-up is going to give you a lot of this context. So, you'd be on the lookout for other systemic conditions. So, if the patient had some arthropathy, if the patient had any pulmonary disease hints, if there was anything else that could lead you on a broader expedition. But I think in the context of this case, acutely in the ER, I probably wouldn't do a big lab plug for this. I probably would kind of go down the most likely road and start our treatments, and then follow that patient up. Dr Smith: Yeah, I know your article does a really great job, I think, of outlining when do you need to think about some of these less common causes. Well, can we talk about treatment, Eric? Because I want to move on to some other things. But- so, we've got a patient with isolated optic neuritis, nothing else, you know, in terms of the other antibodies we've talked about. What state-of-the-care- or, state-of-the-art treatment for that patient? Dr Eggenberger: So, the acute treatment for these inflammatory, optic neuritis-type cases is very similar Initially. High dose steroids remains kind of the standard. And then, in MS-related optic neuritis, we may or may not see a taper. So many times it's just an acute treatment of three to five days high dose. Whether that's oral or PO, we could institute either depending on the particular case. And then the taper would depend on the potential cause. So, for instance, with these antibody-driven diseases---so with MOG- or particularly with aquaporin-4---if it's a longitudinally extensive region of optic nerve involved, we tend to use a longitudinally extensive taper. And so, we use prednisone in those cases for several months while we're getting everything else set and deciding what the overall course is going to bring. Dr Smith: What about IV versus oral? There must be something about my practice. I was telling this to Lindsey. Every time on our hospital service, we seem to have at least two patients with optic neuropathies, which I always enjoy, but I find it's a little weird to admit someone who's doing just fine otherwise to the hospital with three days of IV SOLU-MEDROL. So, I'm always trying to figure out, like, how can I get this patient home? And your article had the best term I've heard in a long time, which is “SOLU smoothies.” I mean, are there other strategies that you sometimes use, other than just high-dose IV methylprednisolone? Dr Eggenberger: So, I agree with you. It's sometimes hard to admit somebody for just an IV therapy. And we'll do this as an outpatient, high-dose IV, but we'll also use high-dose orals. And in times in the past when there's been methylprednisolone shortage, we've used high-dose oral or IV dexamethasone as well. I think the IV form, although it's the gold standard, the high-dose oral forms have pretty equivalent bioavailability and are pretty tolerable in my experience. And certainly more convenient. Dr Smith: I wonder if we should switch and maybe talk a little bit about aquaporin-4, I mean, you emphasized that this is a vicious disease---I love the way you describe that---and often blinding. What updates do you have in terms of our therapeutic approach to NMO? That's been rapidly evolving of late. Dr Eggenberger: Right, so these are cases we're always going to share with neuroimmunology. And it requires kind of a multidisciplinary approach, in my opinion, for ideal or for best outcomes. And so, all of these patients are going to get put on prophylactic medications. So, this is a disease you just can't leave untreated. Bad stuff will happen for sure. And we now, fortunately, have some approved, FDA-approved medications that can positively impact the course of this disease. So, that's been a welcome addition. Dr Smith: What are the FDA-approved medications at this point for NMO? Dr Eggenberger: So, there are several at this point, and this is an area that's in growth, fortunately. And again, these are cases we're going to be sharing with our neuroimmunology colleagues. So, these are IV medications typically aimed at complement or CD19. And they all are relatively effective at quieting the course of the disease. Dr Smith: Maybe we can talk a little bit about MOG? I think that most of our listeners are probably pretty familiar with aquaporin-4 and NMO, what- maybe you could describe MOG a little bit and the therapeutic approach for patients with MOG-associated disease? Dr Eggenberger: So, MOG has been a real interesting kind of condition to learn more about. We certainly see a lot of MOG, and I'm sure we saw MOG before it was formally described, but I think we just thought it was kind of a benign, maybe monophasic MS type of presentation. But MOG tends to come in with a loss of acuity that kind of rivals aquaporin-4. So, the acuity tends to be pretty, pretty depressed, but it's very steroid-responsive. So, a lot of times these are the patients, you'll see that their vision will start to improve even when they're on the initial few days of the high-dose steroids. And many times we can get their vision back to 20/20 or very close to that. Dr Smith: And do these patients need chronic management? Dr Eggenberger: So, that's an area of controversy to some degree. About 50% of the optic neuritis MOG-related cases are going to have a relapsing course. And because the disease is steroid-responsive, many times we'll follow these patients after a first attack to see if this is the condition that's going to declare itself to be relapsing or if this is just going to be a monophasic kind of presentation of optic neuritis. We don't have great biomarkers to separate patients who are going to be in that 50% monophasic course versus the other half. It'll be relapsing. And so, it depends on the patient. If there's somebody that's, as many of these patients are, been very steroid responsive, they get back to 20/20, we can teach them about the disease so that if they do have a relapse, we can get them high-dose steroids in a relatively rapid fashion and they're otherwise healthy, we're probably going to watch that patient. And if it's somebody that doesn't recover 100%, there's other issues with treating them with high-dose steroids potentially in the future, then we may learn more towards an earlier prophylactic approach in that patient. Dr Smith: And what would that approach look like? Is it different from NMO or using more IVIG or B cell depletion as opposed to complement inhibition, for instance? Dr Eggenberger: In MOG, we know that the B cell depletion strategies don't work as well. And so most times we're turning to IVIG, and we found that pretty effective. That's kind of our go-to at this point. Dr Smith: Eric, it's a joy talking to you and I'd love to keep going about content, but I'll refer our listeners to your outstanding article. I mean, you're such a highly regarded neuro-ophthalmologist and educator. I wonder if you could talk to us about why you've done neuro-ophthalmology, and maybe this is an opportunity for you to convince all of our great residents that are listening or students what's great about being a neuro-ophthalmologist. Dr Eggenberger: I think neuro-ophthalmology is by far the most interesting part of neurology. So, it's an area that I think a lot of general neurologists, in my view, don't get enough of in their residency. But it's kind of the essence of neurology, where in neurology you're localizing down to the millimeter and in neuro-ophthalmology,  we're localizing down to the micron level. We have several new emerging diseases like these varieties of optic neuritis we're focused on. We're learning lots about those. You get to be involved in lots of different areas of neurology. So, we'll see not just demyelinating conditions, we'll see trauma as it relates to the visual system. And we'll see tumor, and we see all different flavors, stroke, and in any piece of neurology, commonly we'll have some vision aspect that we that we get involved in. So, we see a wide variety of conditions. So, I think it's been a really exciting place to be within neurology. And it's rapidly changing at this point. We're getting new therapeutics. So, it's, I think it's a great time to be a neuro-ophthalmologist. Dr Smith: Yeah, listening to you talk and just reflecting on it, it's really true. Neuro-ophthalmology does cover the entire span of neurology, right? I'm a neuromuscular guy and we see a lot of ocular myasthenia, which is another super exciting area. But we've been talking about optic neuritis, and your article talks about infectious causes and the paraneoplastic and a whole host of things. So, you're a great advocate and salesperson for your field. You convinced me. Dr Eggenberger: Efferent neuro-ophthalmology we love, we could talk about ocular myasthenia and other aspects for another hour. And we get involved in all kinds of cases: third nerve palsies, ocular myasthenia, trauma that involves the efferent system, all different aspects. It's really a great subspecialty, and you get to see a bit of all of neurology. Dr Smith: I'm trying to remember who it was, Eric. It was an attending of mine at medical school. I went to medical school at the Mayo Clinic in Rochester, and I want to say it was Manny Gomez, who was a very famous tuberous sclerosis person, who told me that neuro-ophthalmology was the most elegant specialty within neurology. That stuck with me. Thank you so much for joining me today. I really appreciate it. Dr Eggenberger: Thank you. I appreciate it as well. Dr Smith: So again, today I've been interviewing Dr Eric Eggenberger about his really wonderful article on optic neuritis, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum audio episodes from the neuro-ophthalmology and other issues. And listeners, thank you very much for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

KCSB's Emerson Good reports on the new mural at Virginia Commonwealth University which honors the memory of Bruce Tucker, a victim of a nonconsensual heart transplant in the 1960s. A story of injustice and legacy, his medical mistreatment resonates deeply in a time when conversations about racial equity are more urgent than ever.

JT Logan is a serial entrepreneur, business coach, author, musician, minister, and father. He is the Founder and CEO of FOURDEEP – a full-service advertising and marketing agency founded in 2011 with offices in Richmond, VA and Washington, DC. JT and the FOURDEEP team have built brands for Fortune 500 companies, global non-profit organizations, universities, faith-based organizations, and emerging businesses alike. JT is also the founder of The Rare Foundation and Breast Cancer Under 30®.JT is focused more than ever to help businesses and organizations transform their products and services through transformative media and marketing. JT's personal life experiences allowed him to redefine his purpose, and help others in the process.JT is a graduate of The Richard T. Robertson School of Media & Culture at Virginia Commonwealth University, with a specialization in Creative and Strategic Advertising. JT is also a graduate of the Samuel Dewitt Proctor School of Theology at Virginia Union University, where he earned his Master of Divinity degree. JT's mission is to help business owners and leaders discover that focusing on purpose, always grows revenue.

Optic neuropathies encompass all congenital or acquired conditions affecting the optic nerve and are often a harbinger of systemic and central nervous system disorders. A systematic approach to identifying the clinical manifestations of specific optic neuropathies is imperative for directing diagnostic assessments, formulating tailored treatment regimens, and identifying broader central nervous system and systemic disorders. In this episode, Gordon Smith, MD, FAAN speaks with Lindsey De Lott, MD, MS, author of the article “Optic Neuropathies” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. De Lott is an assistant professor of neurology and ophthalmology at the University of Michigan in Ann Arbor, Michigan. Additional Resources Read the article: Optic Neuropathies Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Guest: @lindseydelott Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: Hello, this is Dr Gordon Smith. Today I'm interviewing Dr Lindsey De Lott about her article on optic neuropathies, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Lindsey, welcome to the podcast, and perhaps you can introduce yourself to our audience. Dr De Lott: Thank you, Dr Smith. My name is Lindsey De Lott and I am a neurologist and a neuro-ophthalmologist at the University of Michigan. I also serve as the section lead for the Division of Neuro-Ophthalmology, which is actually part of the ophthalmology department rather than the neurology department. And I spend a good portion of my time as a researcher in health services research, and that's now about 60% of my practice or so. Dr Smith: I'm super excited to spend some time talking with you. One, I'm a Michigan person. As we were chatting before this, I trained with Wayne Cornblath and John Trobe, and it's great to have you. I wonder if we maybe can begin- and by the way, your article is outstanding. It is such a huge topic and it was actually really fun to read, so I encourage our listeners to check it out. But you begin by talking about misdiagnosis as being a common problem in this patient population. I wonder if you can talk through why that is and if you have any pearls or pitfalls in avoiding it? Dr De Lott: Yeah, I think there's been a lot of great research looking at misdiagnosis in specific types of optic neuropathies; in particular, compressive optic neuropathies and optic neuritis. A lot of that work has come out of the group at Emory and the group at Washington University. But a lot of neuro-ophthalmologists across the country really contributed to those data. And one of the statistics that always strikes me is that, you know, for example, in patients with optic nerve sheath meningiomas, something like 70% of them are actually misdiagnosed. And a lot of those errors in diagnosis, whether it's for compressive optic neuropathy or some other type of optic neuropathy, really comes down to the way that physicians are really incorporating elements of the history in the physical. For example, in optic neuritis, we know that physicians tend to anchor pretty heavily on pain in general. And that often tends to lead them astray when optic neuritis was never the diagnosis to begin with. So, it's really overindexing on certain things and not paying attention to other features of the physical exam; for example, say presence of an afferent pupillary defect. So, I think it just really highlights the need to have a really relatively structured approach to patients that you think have an optic neuropathy when you're trying to sort of plan your diagnostic testing and your treatment. Dr Smith: I do maybe five or six weeks on our hospital service each year, and I don't know if it's just a Richmond thing, but there's always at least two people in my week who come in with an optic neuropathy or acute vision loss. How common is this in medical practice? Or neurologic practice, I should say? Dr De Lott: Optic neuropathies themselves… if you look across, unfortunately we don't have any great data that puts together all optic neuropathies and gives us an actual sort of prevalence estimate or an incidence estimate from year to year. We do have some of those data for specific types of optic neuropathies like optic neuritis and NAION, and you're probably looking around five-ish per one hundred thousand. So, these aren't that common, but at the same time they do get funneled to- often to emergency rooms and to neurologists from our ophthalmology colleagues and optometry colleagues in particular. Dr Smith: So, one other question I had before kind of diving into the topic at hand is how facile neurologists need to be in recognizing other causes of acute visual loss. I mean, we see acute visual loss as neurologists, we think optic neuropathy, right? Optic neuritis is sort of the go-to in a younger patient, and NAION in someone older. But what do neurologists need to know about other ophthalmologic causes? So, glaucoma or acute retinal disorders, for instance? Dr De Lott: Yeah, I think it's really important that neurologists are able to distinguish optic neuropathies from other causes of vision loss. And so, I would really encourage the listeners to take a look at the excellent article by Nancy Newman about vision loss in this issue where she really kind of breaks it down into vision loss that is acute and chronic and how you really think through distinguishing optic neuropathies from other causes of vision loss. But it is really important. For example, a patient with a central retinal artery occlusion may potentially be eligible for treatments. And that's very different from a patient with optic neuritis and acute vision loss. So, we want to be able to distinguish these things.  Dr Smith: So maybe we can pivot to that a little bit. Just for our listeners, our focus today is going to be on- not so much on optic neuritis, although obviously we need to talk a little bit about how we differentiate optic neuritis from non-neuritis optic neuropathies. It seems like the two most common situations we encounter are ischemic optic neuropathies and optic neuritis. Maybe you can talk a little bit about how you distinguish these two? I mean, some of it's age, some of it's risk factors, some of it's exam. What's the framework, of let's say, a fifty-year-old person comes into the emergency room with acute vision loss and you're worried about an optic neuropathy? Dr De Lott: The first step whenever you are considering an optic neuropathy is just making sure that the features are present. I think, really going back to your earlier question, making sure that the patient has the features of an optic neuropathy that we expect. So, it's not only vision loss, but it's also the presence of an apparent pupillary defect in a patient with a unilateral optic neuropathy. In a person who has a bilateral optic neuropathy, that apparent pupillary defect may not be present because it is relative. So, you really would have to have asymmetric vision loss between the two eyes. They should also have impairment of their color vision, and they're probably going to have some kind of visual field defect, whether that's central scotoma or an arcuate scotoma or an altitudinal defect that really respects the horizontal meridian. So, you want to make sure that, first and foremost, you've got a patient that really meets most of those- most of those features. And then from there, we're looking at the other features on their history. How acute is the onset of the vision loss? What is the progression over time? Is there pain associated or not associated with the vision loss? What other medical issues does the patient have? And you know, one of the things you already brought up, for example, is, what's the age of the patient? So, I'm going to be much more hesitant to make a diagnosis of optic neuritis in a much older patient or a diagnosis on the other side, of ischemic optic neuropathy, in a much younger patient, unless they have really clear features that push me in that direction. Dr Smith: I wonder if maybe you could talk a little bit about features that would push you away from optic neuritis, because, I mean, people who are over fifty do get optic neuritis- Dr De Lott: They do. Dr Smith: -and people who get ischemic optic neuropathies who are younger. So, what features would push you away from optic neuritis and towards… let's be broad, just a different type of optic neuropathy? Dr De Lott: Sure. We know that most patients with optic neuritis do have pain, but that pain is accompanied---within a few days, typically---with vision loss. So, pain alone going on for a number of days without any visual symptoms or any of those other things I listed, like the afferent papillary defect, the visual field defect, would push me away from optic neuritis. But in general, yes, most optic neuritis is indeed painful. So, the presence of optic disc edema is unfortunately one of those things that an optic neuritis may be present, may not be present, but in somebody with ischemia that is anterior---and that's the most common type of ischemic optic neuropathy, would be anterior ischemic optic neuropathy---they have to have optic disc edema for us to be able to make that diagnosis, and that is a diagnosis of NAION, or nonarteritic ischemic optic neuropathy. An APD in this case, again, that's just a feature of an optic neuropathy. It doesn't really help you to distinguish, individual field defects are going to be relatively similar between them. So then in patients, I'm also looking, like I said, at their history. So, in a patient where I'm entertaining a diagnosis of ischemic optic neuropathy, I want to make sure that they have vascular risk factors or that I'm actually doing things like measuring their blood pressure in the office if they haven't seen a physician recently or checking a lipid panel, hemoglobin A1c, those kinds of things, to look for vascular risk factors. One of the other features on exam that might push me more- again, in a patient with ischemic optic neuropathy, where it might suggest ischemia over optic neuritis, would be some other features on exam like a crowded optic disc that we sometimes will see in patients with ischemic optic neuropathy. I feel like that was a bit of a convoluted answer. Dr Smith: I thought that was a great answer. And when you say crowded optic disc, that's the- is that the “disc at risk”? Dr De Lott: That is the “disk at risk,” yes. So, crowded optic disk is really a disk that is smaller than what we see in the average population, and the average cup to disk ratio is 0.3. So, I think that's where 30% of the disk should be. So, this extra wiggle room, as I sometimes will explain to my patients. Dr Smith: And then, I wonder if you could talk a little bit about more- just more about exam, right? You raised the importance of recognizing optic disc edema. Are there aspects of that disc edema that really steer you away from optic neuritis and towards ischemia-like hemorrhages or whatnot? And then a similar question about the importance of careful visual field testing? Dr De Lott: So, on the whole, optic disc edema is optic disc edema. And you can have very severe optic neuritis with hemorrhages, cotton wool spots, which is essentially just an infarction of the retinal nerve fiber layer either overlying the disc or other parts of the retina. And ischemia, you can have some of the same features. In patients who have giant cell arteritis, which is just one form of anterior ischemic optic neuropathy, patients can have a pallid optic disc edema where the optic disc is swollen and white-looking. But on the whole, swelling is swelling. So, I would caution anyone against using the features of the optic nerve swelling to make any type of, sort of, definitive kind of diagnosis. It's worth keeping in mind, but I just- I would caution against using specific features, optic nerve swelling. And then for visual field testing, there are certain patterns that sometimes can be helpful. I think as I mentioned earlier, in patients with ischemic optic neuropathy, we'll often see an altitudinal defect where either the top half or, more commonly, the bottom half of the vision is lost. And that vision loss in the field corresponds to the area of swelling on the disk, which is really rewarding when you're actually able to see sectoral swelling of the disk. So, say the top half of the disk is swollen and you see a really dense inferior defect. And other types of optic neuropathy such as hereditary optic neuropathies, toxic and nutritional optic neuropathies, they often cause more central field loss. And in patients who have optic neuropathies from elevated intracranial pressure, so papilladema, those folks often have more subtle visual field loss in an arcuate pattern. And it's only once the optic nerves have sustained a pretty significant injury that you start to see other patterns of field loss and actual decline in visual acuity in those patients. I do think a detailed visual field assessment can often be pretty helpful as an adjunct to the rest of the exam. Dr Smith: So, we haven't talked a lot about neuroimaging, and obviously, neuroimaging is really important in patients who have optic neuritis. But how about an older patient in whom you suspect ischemic optic neuropathy? Do those patients all need a MRI scan? And if so, is it orbits and brain? How do you- how do you protocol it? Dr De Lott: You're asking such a good question, totally controversial in in some ways. And so, in patients with ischemic optic neuropathy, if you are confident in your diagnosis: the patient is over the age of fifty, they have all the vascular, you know, they have vascular risk factors. And those vascular risk factors are things like diabetes, hypertension, high blood pressure, hyperlipidemia, obstructive sleep apnea. They have a “disc at risk” in the fellow eye. They don't have pain, they don't have a cancer history. Then doing an MRI of the orbits is probably not necessary to rule out another cause. But if you aren't confident that you have all of those features, then you should absolutely do an MRI of the orbit. The MRI of the brain probably doesn't provide you with much additional information. However, if you are trying to distinguish between an ischemic optic neuropathy and, say, maybe an optic neuritis, in those patients we do recommend MRI orbits and brain imaging because the brain does provide additional information about other CNS demyelinating disorders that might be actually the cause of a patient's optic neuritis. Dr Smith: I wonder if you could talk a little bit about posterior ischemic optic neuropathy. That's much less common, and you mentioned earlier that those patients don't have optic disk edema. So, if there's a patient who has vision loss that- in a similar sort of clinical scenario that you talked about, how do you approach that and under what circumstances do we see patients who have posterior ischemic optic neuropathy? Dr De Lott: So, you're going to most often see patients with posterior ischemic optic neuropathy who, for example, have undergone a recent surgery. These are often associated with things like spinal surgeries, cardiac surgeries. And there are a number of risk factors that are associated with it. Things like blood pressure, drain surgery, the amount of blood loss, positioning of patient. And this is something that the surgeons and anesthesiologists are very sensitive to at this point in time, and many patients are often- this can be part of the normal informed consent process at this point in time since this is something that is well-recognized for specific surgeries. In those patients, though… again, unless you're really certain, for example, maybe the inpatient neurology attending and you've been asked to consult on a patient and it's very clear that they went into surgery normal, they came out of surgery with vision loss, and all the rest of the features really seem to be present. I would recommend that in those cases you think about orbital imaging, making sure you're not missing anything else. Again, unless all of the features really are present- and I think that's one of the themes, definitely, throughout this article, is really the importance of neuroimaging in helping us to distinguish between different types of optic neuropathy. Dr Smith: Yeah, I think one of the things that Eric Eggenberger talks about in his article is the need to use precise nomenclature too, which I plan on talking to him about. But I think having this very structured approach- and your article does it very well, I'll tell our listeners who haven't seen it there's a series of really great tables in the article that outline a lot of these. I wonder, Lindsey, if we can switch to talk about arteritic optic neuropathy. Is that okay? Dr De Lott: Sure. Yeah, absolutely. Dr Smith: How do you sort that out in an older patient who comes in with an ischemic optic neuropathy? Dr De Lott: Yeah. In patients who are over the age of fifty with an ischemic optic neuropathy, we always need to be thinking about giant cell arteritis. It is really a diagnosis we cannot afford to miss. If we do miss it, unfortunately, patients are likely to lose vision in their fellow eye about 1/3 to 1/2 the time. So, it is really one of those emergencies in neuro-ophthalmology and neurology. And so you want to do a thorough review systems for giant cell arteritis symptoms, things like headache, jaw claudication, myalgias, unintentional weight loss, fevers, things of that nature. You also want to check their inflammatory markers to look for evidence of an elevated ESR, elevated C-reactive protein. And then on exam, what you're going to find is that it can cause an anterior ischemic optic neuropathy, as I mentioned earlier. It can cause palette optic disc swelling. But giant cell arteritis can also cause posterior ischemic optic neuropathy. And so, it can be present without any swelling of the optic disc. And in fact, you know, you mentioned one of my mentors, John Trobe, who used to say that in a patient where you're entertaining the idea of posterior ischemic optic neuropathy, who is over the age of fifty with no optic disc swelling, you should be thinking about number one, giant cell arteritis; number two, giant cell arteritis; number three, giant cell arteritis. And so, I think that is a real take-home point is making sure that you're thinking of this diagnosis often in our patients who are over the age of fifty, have to rule it out. Dr Smith: I'll ask maybe a simple question. And presumably just about everyone who you see with a presumed ischemic optic neuropathy, even if they don't have clinical features, you at least check a sed rate. Is that true? Dr De Lott: I do. So, I do routinely check sedimentation rate and C-reactive protein. So, you need to check both. And the reason is that there are some patients who have a positive C-reactive protein but a normal sedimentation rate, so. And vice versa, although that is less common. And so both need to be checked. One other lab that sometimes can be helpful is looking at their CBC. You'll often find these patients with giant cell arteritis have elevated platelet counts. And if you can trend them over time, if you happen to have a patient that's had multiple, you'll see it sort of increasing over time. Dr Smith: I'm just thinking about how you sort things out in the middle, right? I mean, so that not all patients with GCF, sky-high sed rate and CRP…. And I'm just thinking of Dr Trobe's wisdom. So, when you're in an uncertain situation, presumably you go ahead and treat with steroids and move to biopsy. Maybe you can talk a bit about that pathway? Dr De Lott: Yeah, sure. Dr Smith: What's the definitive diagnostic process? Do you- for instance, the sed rate is sky-high, do you still get a biopsy? Dr De Lott: Yes. So, biopsy is still our gold-standard diagnosis here in the United States. I will say that is not the case in all parts of the world. In fact, many parts of Europe are moving toward using other ancillary tests in combination with labs and exam, the history, to make a definitive diagnosis of giant cell arteritis. And those tests are things like temporal artery ultrasound. We also, even though we call it temporal artery ultrasound, we actually need to image not only the temporal arteries but also the axillary arteries. The sensitivity and specificity is actually greater in those cases. And then there's high-resolution imaging of the vessels and the- both the intracranial and extracranial distributions. And both of those have shown some promise in their predictive values of patients actually having giant cell arteritis. One caution I would give to our listeners, though, is that, you know, currently in the US, temporal artery biopsy is still the gold standard. And reading the ultrasounds and the MRIs takes a really experienced radiologist. So, unless you really know the diagnostic accuracy at your institution, again, temporal artery biopsy remains the gold standard here. So, when you are considering giant cell arteritis, start the patient on steroids and- that's high dose, high dose steroids. In patients with vision loss, we use high dose intravenous methylprednisolone and then go ahead and get the biopsy. Dr Smith: Super helpful. And are there other treatments, other than steroids? Maybe how long do you keep people on steroids? And let's say you've got a patient who's, you know, diabetic or has other factors that make you want to avoid the course of steroids. Are there other options available? Dr De Lott: So, in the acute phase steroids are the only option. There is no other option. However, long term, yes, we do pretty quickly put patients on tocilizumab, which is really our first-line treatment. And I do that in conjunction with our rheumatology colleagues, who are incredibly helpful in managing and monitoring the tocilizumab for our patients. But when you're seeing the patients, you know, whether it's in the emergency room or in the hospital, those patients need steroids immediately. There are other steroid-sparing agents that have been tried, but the efficacy is not as good as tocilizumab. So, the American College of Rheumatology is really recommending tocilizumab as our first line steroid-sparing agent at this point. Dr Smith: Outstanding. So again, I will refer our listeners to your article. It's just chock-full of great stuff. This has been a great conversation. Thank you so much for joining me today. Dr De Lott: Thank you, Dr Smith. I really appreciate it.  Dr Smith: The pleasure has been all mine, and I know our listeners will be enjoying this as well. Again, today I've been interviewing Dr Lindsey De Lott about her article on optic neuropathies, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. I already mentioned Dr Eggenberger and I will be talking about optic neuritis, which will be a great companion to this discussion. Listeners, thank you for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Send us a textIn episode 761 of The Sharvette Mitchell Radio Show, we're diving into the world of grant writing and nonprofit success with Iva Brown, CEO of Motivating Factors, LLC  and Miata Powell, Marketing Director. With over two decades of experience in nonprofit leadership, government programs, and multi-million dollar budgets, Iva breaks down what it really takes to secure grant funding and build impact-driven organizations.Since 2012, I've been the CEO of Motivating Factors, LLC. My business helps individuals and organizations reach their highest potential. For 9 years I worked for Virginia Commonwealth University, managing an HIV/AIDS program. I worked for housing and homeless non-profit organizations for 15 years, where I served as Director of Operations and Director of Housing. I currently work for the state of Virginia, where I direct the State Opioid Response Program. In that role, I am responsible for an annual budget of $27 million and manage a team of 4 people.In my spare time, I love riding sports motorcycles (Suzuki Hayabusa) and watching sports with my Fiancé, Mont, hanging with my 2 adult daughters Miata and Catera, and caring for my beloved kitty, Ms. Munchie.I am a graduate of the University of Richmond and I'm finishing a Master's in human service counseling at Liberty University.www.motivatingfactorsllc.orgFacebook: https://www.facebook.com/share/1B1SY8WG1K/Instagram: MfactorsllcLinkedIn:  CLICK HEREThe Sharvette Mitchell Radio Show | www.Sharvette.com Listen and Subscribe to our Podcast: https://pod.link/281762250 Listen on Apple Podcast - http://itunes.apple.com/us/podcast/the-sharvette-mitchell-radio/id281762250 Listen on Spotify - https://open.spotify.com/show/6Er67rVhcSqj8MO7ysL9bV Listen on iHeart Radio: https://www.iheart.com/podcast/256-the-sharvette-mitchell-rad-31047507/ Listen on BuzzSprout- https://thesharvettemitchellradioshow.buzzsprout.com Listen on Amazon Music Podcast: https://music.amazon.com/podcasts/7a6dbb45-abf8-4ce7-8202-116b3dbd3f31/the-sharvette-mitchell-radio-show

Behavior specialists suggest habits are responsible for up to 40% of daily actions.  Understanding the role of habits, how they form, and what's required to overcome them is information any supervisor can benefit from.  In this episode, host Joe White provides several suggestions for helping employees move beyond undesired habits that adversely impact workforce performance.View this episode on the AEU website.About JoeAs Director of AEU LEAD, Joe White focuses on helping members transform operational goals into actionable plans through a structured change management process. Prior to joining AEU, Joe was a senior consultant for E.I. DuPont's consulting division, DuPont Sustainable Solutions (DSS). He joined DSS in 2011 to develop the next generation of safety practices using extensive research in behavioral sciences he's compiled over a period of nearly two decades. His efforts resulted in the development of The Risk Factor, which is now the flagship instructor-led offering for the consulting division. Combined, Joe has 26 years of operational safety experience, the majority of which was with DuPont. Joe has been published in Occupational Health & Safety Magazine for his prominent work in safety relative to behavioral and neurosciences and is an event speaker at many leading industry conferences including National Safety Council (NSC) Congress and Expos, American Wind Energy Association (AWEA), and National Maritime Safety Association (NMSA). Joe is a graduate of Virginia Commonwealth University and has a B.S., in Safety and Risk Administration.Where you can find JoeConnect with Joe on LinkedIn======================Supervisor Skills: Secrets of Success is a production of AEU LEAD, a division of The American Equity Underwriters, Inc. With 60 years of combined industry experience, our supervisor training program gives mid-level managers in the maritime industry the skills needed to influence employees, customers, and peers. This increases employee engagement, reduces turnover and rework, and ultimately results in higher profits for their companies. Find AEU: amequity.com | Linkedin | Facebook

Today, we're excited to get to know Dr. Ali Khan, Chief Medical Officer of Aetna Medicare, overseeing healthcare services for over 4 million members. His career spans across some of the most impactful value-based care organizations, including Oak Street Health, CareMore, and Iora Health. He is also an adjunct lecturer at Northwestern University's Kellogg School of Management and serves on the clinical faculty of the Yale School of Medicine. Additionally, Dr. Khan is a director on the American Board of Internal Medicine. Also a trusted advisor on Pear's Health Industry Council.Before Aetna, Dr. Khan played a key role in Oak Street Health's rapid expansion, scaling it from 21 to 200+ clinics, culminating in its acquisition by CVS Health. Prior to that, he was instrumental in CareMore Health's growth and innovation in care delivery for vulnerable populations.He holds an MD-MPP from Virginia Commonwealth University and Harvard Kennedy School, completed his residency at Yale, and has taught at institutions like Northwestern Kellogg and Yale School of Medicine.As a leader in value-based care, he has firsthand experience in building, scaling, and optimizing healthcare startups—making his insights invaluable for founders, investors, and industry leaders navigating the complex world of healthcare innovation.

The Smart 7 is an award winning daily podcast, in association with METRO that gives you everything you need to know in 7 minutes, at 7am, 7 days a week...With over 17 million downloads and consistently charting, including as No. 1 News Podcast on Spotify, we're a trusted source for people every day and the Sunday 7 won a Gold Award as “Best Conversation Starter” in the International Signal Podcast Awards If you're enjoying it, please follow, share, or even post a review, it all helps...Today's episode includes the following guests:Guests: Barry “Butch” WIlmore - NASA Astronaut, US Navy Captain (retired) Suni Williams - NASA Astronaut and ISS Commander for Mission 32 / 33 Nick Hague - NASA Astronaut and US Space Force ColonelRabea Rogge - German Astronaut and first German woman in space Will Guyatt - The Smart 7's Tech Guru Doctor Steven Woolf - Professor of Family Medicine and Population Health at Virginia Commonwealth University,Anna-Katharina Hornidge - Professor for Global Sustainable Development at the University of BonnBenjamin Jones - Economist at Northwestern UniversityProfessor Liz Bentley - The Royal Meteorological SocietyProfessor Tara Spires-Jones - President of the British Neuroscience Association Blake Shook - Beekeeper and the Founder of Desert Creek HoneyJuliana Rangel - Associate Professor of Apiculture at A&M University in TexasSimon Saville - Butterfly Conservation Mark Field - Pembrokeshire Farmer and Twin Donkey owner Dr Andrew Clemence - Veterinary Surgeon Contact us over @TheSmart7pod or visit www.thesmart7.com or find out more at www.metro.co.uk This Episode is presented by Mike Wooller, written by Liam Thompson and produced by Daft Doris. Hosted on Acast. See acast.com/privacy for more information.

Leslie is joined by Dr. Anthony Estreet, PhD, MBA, LCSW-C, CEO of the National Association of Social Workers (NASW).The NASW is the largest membership organization of professional social workers in the world. NASW works to enhance the professional growth and development of its members, to create and maintain professional standards for social workers, and to advance sound social policies. The pair discusses Dr. Estreet's op-ed for Salon, titled, "Trump's Executive Orders Are Exacerbating the Country's Mental Health Crisis." (link here: https://www.salon.com/2025/03/12/executive-orders-are-exacerbating-the-countrys-mental-health/) Dr. Estreet earned a bachelor's in science in psychology from Bowie State University, an MSW at Virginia Commonwealth University, a doctorate in social work at Morgan State University, and an MBA at the University Maryland-College Park. He has been a professor and chair of the Master of Social Work Program at Morgan State University since 2013. Estreet is also founder and chief executive officer of Next Step Treatment Center in Baltimore, which provides substance use treatment and mental health services. The website for the NASW is SocialWorkers.org and you can follow them on BlueSky, where their handle is @naswsocialworkers.bsky.social.

Drs. Z and C welcome Dr. Wally Smith, a leading figure in sickle cell research from Virginia Commonwealth University, to discuss crucial issues affecting adults with sickle cell disease. They explore the neglect of adult patients, the need for dedicated centers, and the value of community health workers. Dr. Smith emphasizes the importance of holistic healthcare solutions, state-level policy initiatives, and community support to improve quality of life and outcomes for sickle cell patients.    SHOW DESCRIPTION Cheat Codes is intended for patients, caregivers, providers, and the greater community of people who are impacted by Sickle Cell Disease.  Each episode, Cheat Codes strives to provide listeners with critical education, the latest scientific updates, and voices from the Sickle Cell community.     TRANSPARENCY STATEMENT  Cheat Codes: A Sickle Cell Podcast is made possible by Agios Pharmaceuticals Inc. Visit Agios.com to learn more. The following Agios-supported programs are intended for informational and educational purposes only and are not intended as medical advice. Please speak with your healthcare professional before making any treatment decisions. Hosts and guests featured in this episode have been compensated for their time.   Join an inclusive community and build connections with other hemolytic anemia allies by following @AllyVoicesRising on Instagram.  

Leslie is joined by Dr. Anthony Estreet, PhD, MBA, LCSW-C, CEO of the National Association of Social Workers (NASW).The NASW is the largest membership organization of professional social workers in the world. NASW works to enhance the professional growth and development of its members, to create and maintain professional standards for social workers, and to advance sound social policies. The pair discusses Dr. Estreet's op-ed for Salon, titled, "Trump's Executive Orders Are Exacerbating the Country's Mental Health Crisis." (link here: https://www.salon.com/2025/03/12/executive-orders-are-exacerbating-the-countrys-mental-health/) Dr. Estreet earned a bachelor's in science in psychology from Bowie State University, an MSW at Virginia Commonwealth University, a doctorate in social work at Morgan State University, and an MBA at the University Maryland-College Park. He has been a professor and chair of the Master of Social Work Program at Morgan State University since 2013. Estreet is also founder and chief executive officer of Next Step Treatment Center in Baltimore, which provides substance use treatment and mental health services. The website for the NASW is SocialWorkers.org and you can follow them on BlueSky, where their handle is @naswsocialworkers.bsky.social.

The Slanted Attic Experience is Proud to Present: EP - 29 "Mait"In this episode of The Slanted Attic Experience, host Tyler welcomes Mait Innes, a first-year medical student at Virginia Commonwealth University with a strong passion for research, seeking to combine clinical knowledge with scientific inquiry to make meaningful contributions to the medical field. Undecided on his specific career path, he is constantly researching and deeply committed to learning, asking pertinent questions, and gaining hands-on experience to discover where his passions lie. Outside of the classroom, Mait enjoys staying active, with a particular love for golf, fishing, and other sports, which provide a balance to the demands of medical school. Although disappointed that the football season is over (true torture for Minnesota Vikings fans everywhere… SKOL), the weather is beginning to change, and he'll soon be back on the course.The episode begins with a discussion on golf, covering Richmond-area courses, a recent golf trip, and insights from the Dominion Energy Classic. Mait and Tyler then break down the process of building a golf bag, the advantages of single-length clubs, and the best indoor and outdoor golf facilities in the area.The conversation transitions into commercial construction, focusing on general contracting and the contractor-architect relationship, highlighting challenges and collaboration in large-scale projects.Shifting into medicine, Mait shares his experiences at VCU, detailing his cardiology research and its broader implications. They examine the role of mentorship, networking, and career development strategies, comparing scribing vs. research as early pathways in medical education.The discussion expands into physician burnout, with an analysis of its causes and prevention, including the role of diet and exercise. They also explore the business side of healthcare and public medical education, considering how financial and educational structures influence healthcare accessibility.Mait outlines key aspects of the medical training process, including Match Day, licensing renewal, and continuing education. The conversation also covers emerging medical technologies, particularly robotic-assisted surgery and the da Vinci system.Beyond medicine, they discuss passion projects, intellectual curiosity, and the art of conversation. They explore twin studies and research methodologies, as well as tribalism's impact on psychology and society.The episode wraps up with reflections on continuous learning and the evolving nature of personal and professional growth.New episodes of The Slanted Attic Experience drop bi-weekly on Mondays at 10:30 AM. Stay updated and access all content through our Linktree.

A federal judge in Maryland has temporarily ordered the reinstatement of grants for teacher preparation programs. A long-standing program at Virginia Commonwealth University in Richmond is one of them.  In other news: Remembering a longtime Virginia judge who recently died; Hanover County to weigh expansion of Ashcake Road Landfill; Gov. Glenn Youngkin has signed 180 bills — and more Central Virginia news.  P.S.: Here's a direct link to the Rivanna e-waste collection day registration.  

“Architainment”. You might hate the term, but Sam has embraced it as it perfectly describes what he does. Coming from the theatre world, and tiring of tech week and the cue-to-cue's, Sam moved into the 9 to 5(-ish) world of architectural lighting. He still holds onto that creative theatricality and applies it to theme parks, building facades, and bridges. But that doesn't mean the work headaches have gone away. Listen to his story about the Manhattan building project that started out great, but devolved into weeks of extra work when the contractor fell behind. Sam is the sole proprietor of At Full Lighting, a company that specializes in large-scale entertainment and architectural lighting installations. Before starting At Full Lighting, he held various positions in many different areas of the lighting industry. He's sailed the high seas as shipwide show control on cruise ships, spent ten months living in Dubai commissioning & programming a new amusement park, and has volunteered his time at the Edinburgh Fringe Festival two years in a row. Sam has worked for various manufacturers and lighting integrators in the US and abroad, acting in various roles such as Project Manager, Service Technician, and Programmer. He has been an ETC Factory Certified Technician for twelve years and a member of their Advanced Programmers Group for the last eleven. He is also a certified trainer for ETC's Eos line of consoles. He received a BFA in Theatrical Lighting Design from Virginia Commonwealth University. Sam has been based out of New York for the past thirteen years.

Keywords: Doxa, Opinions, Digital Rhetoric, Social Media, Internet Culture. Caddie Alford is Associate Professor of Rhetoric and Writing in the English Department at Virginia Commonwealth University. She is the author of the book Entitled Opinions: Doxa After Digitality (2024). She is a digital rhetoric expert who researches emergent forms of persuasion, sociality, and the changing state of information vis-à-vis social media platforms and technological developments and ideologies. Some of her work has appeared in The Quarterly Journal of Speech; Rhetoric Review; and Enculturation. She served as the book review editor for the journal Enculturation for three years. She is currently co-editing a rhetorical studies collection on “post-truth” rhetorics. Visit thebigrhetoricalpodcast.weebly.com and follow @thebigrhet.Visit thebigrhetoricalpodcast.weebly.com and follow @thebigrhet.

Dave talks with Ellen Carpenter of Virginia Commonwealth University and Alan Strathman of the University of Central Missouri about what "late career" means and how we make decisions about what things to take on and when to say no. It is possible to be late career in a broad sense but also be early in the process of taking on different responsibilities. We also chat about our experiences using teaching technology over the years, and how to make decisions both about what technology to use and about improving our teaching in general.

In this special collaboration with NephMadness, we're diving into the world of nephrotoxins with an expert panel from Virginia Commonwealth University. NephMadness is an educational competition modeled after March Madness, and this year, one of the featured regions focuses on plant-based nephrotoxins. Together, with our expert panel we break down the competing nephrotoxin teams: Tubular Toxins vs. Oxalate Offenders. Joining us are Dr. Anna Vinnokova (Nephrologist), Dr. Rachel Khan PharmD (Neph pharmacist), Dr. Ethan Downes (Nephrology fellow), and the legendary nephrotoxicologist, Dr. Josh King (Board certified Nephrologist and Toxicologist). We ALMOST named this episode "Getting Downe with the Mad Neph King and the Bean Queens"... but we didn't, your welcome. After the show, go to the blog and vote for your favorite!Expect irreverent musings, deep dives into toxic plant exposures, and a mystery case reveal that will leave you questioning your diet.Topics and Timeline of Episode:IntroListener Guesses With Josh and Ryan– 8:30Listener Winner – 25:42NephMadness and Guest Introductions – 28:07Toxin Reveal – 33:41NEJM Case reportTubular Toxins – 35:46Aristolochic Acid & the Belgian Weight-Loss Clinic Outbreak – 40:30Black Licorice & Its Surprising Toxic Effects – 47:16The Oxalate Offenders Team: How Dietary Oxalates Harm the Kidneys – 52:00Historical Context: First recognized through sheep die-offs when herds grazed on Halogeton glomeratus, a high-oxalate plant, leading to fatal poisoning.Oxalate in Plants: Functions to bind excess calcium in the soil.Impact on the Body: Plants high in oxalate but low in calcium can contribute to oxalate accumulation, this leads to binding calcium in the blood, creating calcium oxalate crystals and acute renal calculi. Chronic inflammation from excess oxalate deposition leads to CKD progression.High-Oxalate Foods: Spinach, Swiss chard, rhubarb, cashews. Everything in moderation!Practical Advice for Clinicians & Patients on Herbal Medicine Use – 1:00:00Resources for identifying nephrotoxic herbal productsTalk to your patients non judgmentally, open conversations, discuss efficacy (or lack there of, see resources below) and safetyHerbal medicines are not FDA approved and may not contain what they claim toHerbals may not all be safe: Josh King Discovering Contaminants– 1:01:11Wrap up– 1:08Key Takeaways:Aristolochic acid is a direct nephrotoxin, associated with progressive kidney damage and urothelial cancers.Black licorice toxicity results from...

In this episode Eric interviews Kim Case from Virginia Commonwealth University in Richmond, VA. Kim discusses the balance of in-person versus online teaching, the pros and cons, and the human connection often lost in an online format. She shares her experience of a profound teaching stint in Italy and the importance of building genuine relationships in academia. The conversation also delves into the economic and moral complexities of offering expertise for free, especially in DEI work. Kim concludes by discussing academic myths and the importance of questioning long-standing norms in higher education to reduce stress and improve efficiency. Resources: https://psycnet.apa.org/fulltext/2022-28577-001.html https://drkimcase.com/free/ https://drkimcase.com/resources/ [Note. Portions of the show notes were generated by Descript AI.]

Genetic testing plays a key role in the evaluation of epilepsy patients. With the expanding number of choices for genetic tests and the complexity of interpretation of results, genetic literacy and knowledge of the most common genetic epilepsies are important for high-quality clinical practice. In this episode, Gordon Smith, MD, FAAN speaks Sudha Kilaru Kessler, MD, MSCE, author of the article “Epilepsy Genetics,” in the Continuum February 2025 Epilepsy issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Kessler is an associate professor of neurology and pediatrics at Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia in Philadelphia, Pennsylvania. ADDITIONAL RESOURCES Read the article: Epilepsy Genetics Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the Academy of Neurology: aan.com SOCIAL MEDIA facebook.com/continuumcme @ContinuumAAN  Host: @gordonsmithMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Smith: Hello, this is Dr Gordon Smith. Today I've got the great pleasure of interviewing Dr Sudha Kessler about her article on epilepsy genetics, which appears in the February 2025 Continuum issue on epilepsy. Sudha, welcome to the podcast and please introduce yourself to our audience. Dr Kessler: Oh, thank you so much. I'm Sudha Kessler. I am a pediatric epileptologist here at the Children's Hospital of Philadelphia and the University of Pennsylvania. Dr Smith: Tell us a little bit about yourself. Are you a geneticist too, or how did you get into this particular topic? Dr Kessler: Yes, I want to emphatically say that I am not a geneticist. I'm not an expert in epilepsy genetics at all. I take care of all sorts of patients with epilepsy. I actually do mostly epilepsy surgery-related care. But this part of epilepsy is, every year, increasingly important to our everyday practice. And I think it's fascinating, often a little daunting. I think I was asked to get involved with this article as a non-expert to help translate from the experts to the rest of us. Dr Smith: We're going to get there, because one of the things you do a really good job of in the article is talking about genetic concepts that are germane to everything we do. And I think you're an expert. You do it in a way that I understood. So, I'd like to get there, but- and this is a really hot area. For instance, I really loved your figure that shows the arc of discovery of genetic causes for epilepsy. It's really breathtaking, something we wouldn't have thought possible that long ago. And it's also a lot to digest. And so, I wonder if maybe we can begin by thinking about a framework and, for instance, you talk about these different groups of disorders. And one that seems to be particularly impacted by this unbelievable A-rated discovery. Our developmental and epileptic encephalopathies, or DEEs. What can you tell our listeners about that group of disorders? Dr Kessler: Sure. I think that, you know, most of what we think about in epilepsy genetics now has to do with disorders that are attributable to changes in a single gene. Genetics is obviously much more complicated than that, but that's still where we are in the stage of discovery. And the graph in the article is definitely one to take a look at because it represents the explosion that we've had in our understanding of single gene disorders leading to epilepsy and related manifestations. The DEEs are a group of disorders where any individual disorder is fairly rare, but as a group they are not that rare, and very impactful because they often cause epilepsy at a very young age. And either as a consequence of seizures or as a consequence of the underlying pathophysiology of that gene change, they are typically associated with really significant developmental impairments for a child 's entire life. Dr Smith: My understanding is that there's therapeutic development going on in this space. So, the early recognition of these genetic testing offers the promise of very impactful treatment---like we now do for SMA, for instance---early in the disease course. Dr Kessler: I think that's right. That's one of the most exciting parts of this field is that so much, just around the corner, for drug development, therapy development in this area. And as you can imagine, with a lot of these disorders, earlier intervention is likely to be much more impactful than later intervention when a lot of the developmental consequences are sort of… you know, when the cat 's already out of the bag, so to speak. Dr Smith: Yeah. So, this is really transformational and something that everyone who takes care of kids with epilepsy needs to know about, it seems. So on the other extreme, I guess, there are the self-limited epilepsies. I didn't really know about this in terms of genetic discovery, but can you talk about those disorders? Dr Kessler: Yeah, sure. I mean, I think some of these are the classic childhood epilepsy syndromes that we think about like childhood absence epilepsy or what we used to call benign romantic epilepsy and now call self-limited epilepsy of childhood with centrotemporal spikes. It's a mouthful, shortened to SeLECTS. Those are the epilepsies that occur typically in previously healthy children, that affects them for a few years and often remits so that epilepsy is just age-limited and doesn't continue for life. They clearly have genetic influences because they tend to run in families, but the genetics of them is not generally single gene associated. And so, we haven't actually explained why most of those kids actually get epilepsy. I think that'll be sort of another interesting area of discovery that will help us even understand some really fundamental things about epilepsy, like, why does this syndrome start at this age and tend to resolve by adolescence? Dr Smith: And the other thing I found interesting is disorders that I might have thought going into it would have a defined genetic cause or some of the disorders that there are not. So JME, for instance, or childhood absence, which is a little counterintuitive. Dr Kessler: It's completely counterintuitive. We call them genetic generalized epilepsies, and we know that they run in families, but we still know so little. I would say of all of the disorders that are mentioned in this article, that is the group where I think we have explained the genetic underpinnings the least well. Dr Smith: Yeah. Isn't that interesting? It's… wasn't it Yogi Berra who said, it's hard to predict things, particularly the future? So… Dr Kessler: Yes. Dr Smith: Who would have thought? So, we've talked a lot about kids. What about adults? You know, what role does genetic testing play in adults who have unexplained epilepsy? Dr Kessler: Yeah, I think that that is also a really important emerging area of knowledge. I think many epileptologists may think of genetic epilepsy as being solely pediatric. There are definitely not how many of these disorders can manifest for the first time in adulthood. Not only that, many of our children with childhood onset epilepsy that is due to a genetic problem grow up to become adults and will then need adult epilepsy care. In order to take care of both of those groups, it's really important for all epileptologists, including those that take care of adults, to have some knowledge of the potential impact of genetic testing. And how do you even approach thinking about it? Dr Smith: The message I guess I'm getting is if our listeners take care of patients with epilepsy, no matter how old those patients are, they need to be familiar with this. And the other message I'm getting is, it sounds like there are a lot of patients who really need genetic testing. And this came through in one aspect of your article that I found really interesting, right? So, what are the recommendations on genetic testing? So, the National Society of Genetic Counselors, as I understand it, said everyone needs genetic testing, right? Which I mean, they're genetic counselors, so. Which is great. In the International League Against Epilepsy, they recommended a more targeted approach. So, what's your recommendation? Should we be testing anyone with unexplained epilepsy, or should we be focusing on particular populations? Dr Kessler: Well, I guess I think about it as a gradation. There are certain populations that really deserve genetic testing, where it is going to be absolutely critical. You know, it's very likely that it will be critical knowledge to their care. If you diagnose somebody with epilepsy and you do imaging and that imaging does not reveal an answer, meaning you don't see a tumor or you don't see an old stroke or some other sort of acquired lesion, the next pillar of testing for understanding underlying etiology is genetic testing. That is the point at which I typically send my patients, and that's whether they're refractory or not. I think in the past some people felt that only patients with refractory epilepsy deserve or require testing. I think the reason why not to limit it to that population is that what's on a person's mind with epilepsy, or a family's mind with epilepsy, is what's going to happen to my child or to me in the future? And if genetic testing can shed some light on that, that will have a huge impact on that person's life. Dr Smith: You've got great cases in your article, which, I just want to give you a compliment. The information and entertainment, frankly, for per page: off the charts. It's not a long article, packed with useful information. And, I mean, some of your cases are great examples of patients who are heading down the surgical epilepsy path and you discovered, nope, there's a genetic cause that really impacted their care. What's the yield, right? The number of patients that you send genetic testing on for epilepsy, what percentage come back positive for a relevant sequence variant that you think is either causing or contributing to their epilepsy? Dr Kessler: That's a great question. I think that is actually still in flux because it depends on the population of patients that are being sent for testing, obviously, and then also on what testing is being done. So, I know in at least one large recent meta-analysis, the overall yield was 17%. And somebody hearing that number might think, oh, that's not very high, but it's actually very comparable to the yield for imaging. And we all do MRIs and patients that have new-onset epilepsy where the yield of MRI testing is about 20%  or so. So, quite comparable. And then with children with DEEs, the yield is much, much higher than that. Dr Smith: So, 17% is actually a really great diagnostic yield. When I think of my yield and doing genetic testing on patients who have an axonal CMT phenotype, right? I mean that's better than what I get. So, good for you. That's exciting. Dr Kessler: It's interesting. I think that maybe an assumption might be that you're working somebody up. You do a genetic test, it reveals a difference, and thus surgery is off the table. It's actually quite different than the head, which is that some results may make surgery be even more “on the table” because you might find a gene that is known to be associated with a propensity to vocal cortical dysplasia, for example. And you may take a good second look at that person's MRI imaging or do other imaging to reveal the MRI invisible vocal cortical dysplasia. Dr Smith: Outstanding point. Let's talk a little more about the genetic testing itself. So, we've got all these genes. We understand when to test. What do you do? For instance, last night I just looked at the company that we use for most of our neuromuscular testing and they have a genetic epilepsy next gen panel with, I don't know, three hundred and twenty genes, right? Do you use that kind of panel? Do you go directly to a whole EXO? What's the right approach? Dr Kessler: Yeah, I think that that is quite dynamic right now, meaning that recommendations seem to change often enough that I rely on help. I have the enormous good luck of working here at CHOP where there is a fantastic epilepsy genetics group that I can easily refer to, and I know not everyone has that resource. The current recommendation is to start with an exome if that is available and is covered by that patient's insurance. When exome is not available, then the next best thing is a gene panel. You know, in recent years there have been a lot of sponsored gene panels, meaning free to the patient, administered by a company that then, you know, has other uses for compiled or grouped genetic data. And I think that as long as all of that can be clearly explained to a patient, and- along with all of the other things so you have to explain to a patient before doing genetic testing, about the pluses and minuses of doing it, I think that you sort of go for the best test you can that's available to that patient. Dr Smith: The sponsored programs can be very, very helpful, particularly from a payer or a patient payment perspective. And so, I guess the lesson there is it's great if you got the resources and CHOP to help you decide, but better to get whatever panel you can get than to do nothing; or, of course, refer to a center if you're not comfortable. Dr Kessler: And also, just know that these things change often enough that if it's been a couple of years and you might want to recheck whether the EXO is available to that patient or whether a gene panel can be sent that includes more than they had eight years ago. Dr Smith: So, are there situations to go to the other extreme where you just do targeted sanger sequencing? Like, just sequence the specific gene of interest?  Dr Kessler: Yeah, absolutely. I'm still a big proponent of thinking clinically about a patient. If there are clues in that patient's history, exam, imaging, anything that gives you some sense of the disorder that this patient might have. And I think a classic example would be tuberous sclerosis. If you see an infant who has new onset spasms, you see hypopigmented macules on their skin and their MRI shows a tuber, you know, also known as a focal cortical dysplasia, then sure, send the targeted sequencing for the TSC1 and TSC2 genes. Dr Smith: And Rett syndrome?  Dr Kessler: And Rett syndrome would be another example. And there are many examples where, if you feel like you have a good sense of what the disorder is, I think it's completely acceptable to send the targeted testing.  Dr Smith: So, I'm going to get further down the rabbit hole and get to from easier to harder. I always get confused about things like chromosomal microarrays or, like, karyotypes and rings and stuff like that. What role do these tests play and what do our listeners need to know about them? Dr Kessler: Yeah, I think that it is really important to have at least some knowledge of what each test can't tell you. I tell my medical students at my residence that all the time. With anything in medicine, you should know what you're asking of a test and what answers a test can tell you and can't tell you. It is baseline knowledge before requesting anything. And if you don't know, then it's best to ask. So, chromosomal microarray is used when you think that there is a large-scale derangement in a bunch of genes, meaning there is a whole section of a chromosome missing---that would be deletion, or that that information is duplicated or is turned around in a, you know, in a translocation. That is what- the kinds of things that that test can tell you. I think of doing a microarray when a child has not just epilepsy and intellectual disability, but also has, for example, other organ systems involved, because sections of chromosome can include many, many, many different genes and it can affect the body in larger ways. That's often when I think about that. So, a child with multiple congenital anomalies. Karyotype, which we think of as the most old-fashioned way of looking at our genes, still has some utility because it is useful for looking at a specific situation where the ends of arm of a chromosome get cut off and get sticky and then stick to each other and make a ring. For example, ring chromosome 20 is a disorder which can cause epilepsy, particularly hard-to-treat frontal lobe epilepsy, and that sometimes doesn't show up until adolescence or even early adulthood. That's just one example of something that karyotype can tell you.  Dr Smith: And it goes without saying, but just to emphasize, these are things that you would miss completely on a next generation panel or a next genome? Dr Kessler: That's correct. Because this isn't about sequencing. This is about large structures. You know, with my patients, it's sometimes, I think, very hard to explain. It's hard enough to explain it to other physicians who aren't in genetics, but it's a whole other undertaking to explain it to families who may not have a lot of literacy about cell biology or genetics or, you know, anything related to that. So, I often rely on analogies. And one analogy I use is that if you're- all of your genetic information is like a book, that book is split into chapters and those are the chromosomes. And you can be missing entire paragraphs or have paragraphs duplicated. And that would be the kind of thing that we would be looking for with the chromosomal microarray with sequencing or, you know, with sequencing, we're looking for spelling of words, and we can look at one word at a time. That would be targeted sequencing. Or we can look at many, many words at a time. And that would be next gen sequencing.  Dr Smith: I just want to say that you are the genetic whisperer. You know, translator. I love it.  Dr Kessler: You can continue using it down to the level of explaining the possibility of a variant of unknown significance, which I think is sometimes difficult to explain. So, I often will say, I know how the word color is spelled: C O L O R. But sometimes in other places it will be spelled C O L O U R and that's still the same word, that's still color. That's just what we would call a population variant. If it is spelled C O M O R, that changes meaning; that is not a word, and that is probably a pathogenic variant. But if it gets misspelled and it's K O L O R, then I'm not sure. Could that be a variant that means something different or not. And so that I would call that a variant of unknown significance, meaning its impact is to be determined. Dr Smith: So, I was going to ask you about variant calling, but you'd beat me to the punch. And that's a great metaphor that I will definitely remember. All right, here's another concept that I think people often find challenging, which is read depth. Can you tell us about reading depth or sequence depth?  Dr Kessler: Yes, hopefully I can. Again, not an expert here, but as I understand it, the way next gen sequencing works is that pieces of DNA are getting read. And the number of times any given nucleotide is read in this process is the read depth. It basically just translates to the number of times the processor, the machinery of doing this, pays attention to anyone site. The reason it's important is that the process by which this reading is done can sometimes result in errors. The greater your depth, the more times something is read, the less likely you are to have a mistake.  Dr Smith: In either direction. So, you're presumably less likely to have a false positive or false negative. Yep, again, very well explained. You know, I've got a lot of other questions I want to ask you, but I do want to be respectful of our listeners' time. I wonder if we could pivot a little bit and just let's go back to where we began. Really exciting time, right? Amazing. And you've been doing this long enough. I'm sure you didn't think when you started that it was going to look like this. What does the future look like? I mean, we talked a little bit about therapeutics, but the world's changing fast. Five, ten years from now, what's your hope for that?  Dr Kessler: Oh, that's such a great question. You know, we are at the point with genetic epilepsies that gene-based therapies, either antisense oligonucleotide-based therapies or viral vector-based gene therapies, are actually now being developed and administered in trial situations to actual patients. And so, it always feels like we're on the cusp, but I think actually now we really are on the cusp of having gene-based therapies for genetic epilepsies. I think that there is still so much to sort out, both from basic scientific point and from a practical administering these things to patients and what are the potential long term consequences.For example, unlike medications, which are therapies that you can stop if there are adverse effects, often administering a gene therapy is a one-and-done thing that can't be retracted. Thinking even about the ethical framework of that and the framework of explaining to patients that we don't know the ten, twenty-year consequences of that, is part of the informed consent process, for example. So, there's still so much work that is going to be transformational, not just from the, you know, the big picture, but from developing all, you know, from going through all of these steps to really make these kinds of therapies a reality. Dr Smith: Well, it's really amazing. And, you know, we're seeing this in multiple different areas in neurology. So, well done. You run the child neurology residency program there, I understand. I try to snoop on people before I talk to them because we haven't met before this. And you're obviously a very a very good educator. Thank you so much for talking with me today. I don't spend a lot of time in epilepsy, but every time I do one of these, I kind of want to go back and do something different because it's such a neat field. Thank you.  Dr Kessler: You're welcome. It was my pleasure.  Dr Smith: Again, today I've been interviewing Dr Sudha Kessler about her article on epilepsy genetics, which is truly outstanding. This article appears in the most recent issue of Continuum on epilepsy. Be sure to check out Continuum audio episodes from this and other issues. And thank you, listeners, for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Send us a text Coach Phil Reichhoff is the Director of Strength and Conditioning at Cape Henry Collegiate in Virginia Beach, Virginia. At Cape Henry Reichhoff Created the school's first strength and conditioning program with curriculum spanning Pre-Kindergarten to Grade 12. Prior to Cape Henry, Coach Reichhoff worked as the strength and conditioning intern for the Washington Wizards where he worked directly with the NBA organization assisting with all elements of performance. Coach Reichhoff worked as a Graduate Assistant Strength and Conditioning Coach at Virginia Commonwealth University. At VCU he oversaw the development of Track and Field Throwers, Men's and Women's Tennis, and Men's Golf. During his time at VCU he was a part of six Atlantic- 10 Conference Championships across sports. Coach Reichhoff started coaching at East Carolina University, assisting with the strength and conditioning training of all 16 NCAA Division I athletic programs. He specifically worked most closely with ECU Football and Baseball, both teams achieved national top 25 rankings multiple times. He has also worked and studied internationally at the Dutch Olympic Training Center, England, Ireland, and France. Reichhoff has a Master of Education from the VCU Center for Sport Leadership, a Bachelor's of Science in Health and Human Performance from East Carolina University,along with a Minor in Sports Performance Enhancement from the HAN University of Applied Sciences. Coach Reichhoff is a RSCC, CSCS, TPI Fitness Level 2, and USA Weightlifting certified coach.https://www.instagram.com/coach_philr?igsh=c3lnOGw3YXN3Z3Jqhttps://coachphilswarmup.beehiiv.com/p/8-5-3method?draft=true--&fbclid=PAZXh0bgNhZW0CMTEAAaY6sF64NdfNZfZhPSwco8e8dpHVVX6okaBn1Z7UqCLA-_7iej2U_AWnDzI_aem_5KvKjgg_gc08r6D4plVEfwhttps://x.com/philreichhoff?s=21https://youtube.com/@platesandpancakes4593https://instagram.com/voodoo4power?igshid=YmMyMTA2M2Y=https://voodoo4ranch.com/To possibly be a guest or support the show email Voodoo4ranch@gmail.comhttps://www.paypal.com/paypalme/voodoo4ranch

In this episode of Voices in Leadership, Jenny Inker, MBA, MS, PhD, LALFA, and Jennifer Yanez Pryor, MA, MS, LALFA, from Virginia Commonwealth University's Department of Gerontology, explore the evolving landscape of assisted living. They discuss pressing challenges such as workforce burnout, recruitment struggles, and the need for a person-centered approach to care. The conversation also highlights innovative care models and key projects, including their upcoming book on assisted living administration and an online Residential Care/Assisted Living (RCAL) exam prep course.Voices in Leadership is produced by Association Briefings.

Kikau and Matty chat with the remarkable Valeria Accetta, who is the Head of Musical Theatre at The University of Alabama at Birmingham. Her recommendation is an app called the Healthy Minds App and a book called Monsters: A Fan's Dilemma by Claire Dederer. Valerie is a member of Actor's Equity Association, an Associate Member of Stage Directors and Choreographers, and an Estill Master Trainer in Estill Voice Training. As an Equity actress, Valerie played Margy Frake in the First National Tour of Rodgers and Hammerstein's State Fair, starring John Davidson. She has performed in numerous other musicals including the title role in Cinderella, Maria in The Sound of Music, and Lady Larkin in Once Upon a Mattress, and she performs regularly in concerts and cabarets. She first began her studies in musical theatre at the University of Miami and received a BA in Musical Theatre Pedagogy from Otterbein University and an MFA in Theatre Pedagogy from Virginia Commonwealth University.

This next guest is a character actor from Falls Church, VA that went on to earn his BFA from Virginia Commonwealth University & began performing in the Off-Off-Broadway theater circuit, however he is probably best known for his portrayal of Victor Pascow in the 1989 classic “Pet Sematary”. Let's welcome Actor Brad Greenquist.*Executive brought up was Lindsay Doran-Producer/Studio Executive*Brad GreenquistWebsite: https://bradgreenquist.com/Crazy Train RadioFacebook: facebook.com/realctradioInstagram: @crazytrainradioX/Twitter: @realctradioBlueSky: @crazytrainradio.bsky.socialWebsite: crazytrainradio.usYouTube: youtube.com/crazytrainradio

Representative Rob Wittman is a Republican representing Virginia's 1st Congressional district in the US House of Representatives. Representative Pat Ryan is a Democrat representing New York's 18th Congressional district, and is a former Army intelligence officer who deployed to Iraq.  Together, they formed the House Modernization Caucus, driving key policies in national security innovation. On this episode of the Defense Tech Underground, Representative Wittman and Representative Ryan discuss the launch of the bipartisan Defense Modernization Caucus and early wins from the caucus in the 2025 NDAA. They explain the challenges for the Pentagon to move from a hardware centric organization to a software centric one, and discuss opportunities for the caucus to drive impact in defense innovation.  This episode is hosted by Jeff Phaneuf and Helen Phillips.    Congressman Wittman:  Congressman Rob Wittman was first elected to the United States Congress to serve Virginia's First Congressional District in 2007. While in office, he has focused on strengthening our military and supporting our nation's veterans, promoting a flourishing economy through fiscal responsibility and pro-growth policies, fixing our crumbling infrastructure, increasing access to high-speed internet, and promoting workforce development through Career and Technical Education (CTE) and Science, Technology, Engineering, and Math (STEM) programs. In the U.S. Congress, Congressman Wittman serves as vice chairman of both the House Armed Services Committee and the House Natural Resources Committee, where he is well-positioned to represent the needs of Virginia's First District. He has earned a strong reputation for being an advocate for our men and women in uniform and for being a champion of the Chesapeake Bay. Congressman Wittman was re-elected for his ninth full term in the U.S. House of Representatives in November 2024 and prior to that, he served in several levels of government. Congressman Wittman won his first campaign for public office in 1986 when he was elected to the Montross Town Council, where he served for 10 years, four of them as mayor. In 1995, he was elected to the Westmoreland County Board of Supervisors and was elected its chairman in 2003. In 2005, voters in the 99th Legislative District elected Rob to the Virginia House of Delegates, where he served until his election to the U.S. House of Representatives in 2007. Prior to his election to Congress, Rob spent 26 years working in state government, most recently as field director for the Virginia Health Department's Division of Shellfish Sanitation. Earlier in his career, he worked as an environmental health specialist for local health departments in Virginia's Northern Neck and Middle Peninsula regions. He holds a Ph.D. in Public Policy and Administration from Virginia Commonwealth University, a Master of Public Health degree in Health Policy and Administration from the University of North Carolina, and a Bachelor of Science degree in Biology from Virginia Tech.   Congressman Ryan:  Congressman Pat Ryan is a fifth-generation Hudson Valley native, proud Kingston High School alum, and the first West Point graduate to represent the Academy in the U.S. House of Representatives. Ryan served two combat tours in Iraq, earning two Bronze Stars. Prior to his 2022 election to Congress, Ryan served the community that raised him as Ulster County Executive. There, Ryan led the County through the COVID-19 pandemic and spearheaded policies that delivered relief to working families while never raising taxes. He led the charge to revitalize the former IBM site, now known as iPark 87, helped put money back in small business owners and residents' pockets, took on corporate special interests, and delivered new investments in mental health services. In Congress, Ryan is focused on defending fundamental freedoms and delivering relief for Hudson Valley families. Serving on the House Armed Services Committee, Ryan is working on issues of military preparedness, countering the threat of a rising China, and investing in the United States Military Academy and the next generation of military leaders. As a member of the Transportation and Infrastructure Committee, Ryan is committed to improving the daily lives of all residents in NY-18. Whether you commute to work on Metro North, travel Route 17 through Orange County, or need broadband access in Dutchess County, he will fight every day to improve our region's infrastructure. Ryan has also championed efforts to expand access to affordable health care, support local law enforcement, preserve Social Security and Medicare, prevent gun violence, and protect a woman's right to choose. Ryan lives in Gardiner, NY with his wife, Rebecca, and their two young sons, Theo and Cameron.

Matty and Kikau discuss all things A.I. (Artificial Intelligence) related when it comes to teaching MT with Lisa Hermanson who is an Assistant Professor of Musical Theatre in the New Mexico State Department of Theatre. At the end of the episode, Lisa recommends a podcast called Normal Gossip, which "delivers juicy, strange, funny, and utterly banal gossip about people you'll never know and never meet. Host Kelsey McKinney discusses reader-submitted comedic gossip with guests, diving into the lives and decisions of complete strangers. " Lisa is originally from Seattle, Washington. She holds her MFA in Theatre Pedagogy/Performance from Virginia Commonwealth University, where she was also adjunct faculty in Theatre and Speech, and her BA in Theatre and Music from Seattle Pacific University. Lisa is a music director, director, pianist, vocalist, and composer/playwright. She has worked in theatres in both the Seattle and Richmond areas, including Virginia Repertory Theatre (Richmond, VA) and the 5th Avenue Theatre (Seattle, WA), as well as multiple years in theatre education in Seattle.

In early September 2005, 17-year-old Taylor Behl, a Virginia Commonwealth University freshman, disappeared from the Richmond campus. A police investigation eventually uncovered her association with Ben Fawley, a 38-year-old man who confessed to having sex with Taylor. “48 Hours" correspondent Erin Moriarty reports. This classic "48 Hours" episode last aired on 7/7/2007. Watch all-new episodes of “48 Hours” on Saturdays, and stream on demand on Paramount+.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Michelle Peace is an internationally recognized forensic toxicologist and a Full Professor in the Department of Forensic Science at Virginia Commonwealth University. The National Institute of Justice has funded her team to study the proliferation of semi-synthetic THC analogs in the unregulated market and define their relevant biomarkers. Her work impacts public health and public safety policies and initiatives. At CannMed 25 Michelle will present “Why Some People “Green Out”? The Analysis of Unregulated “Hemp-derived” Cannabis Products”. Her team used a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to analyze unregulated hemp products. All the products they analyzed were mislabeled in some way, either misrepresenting the cannabinoids contained therein or their concentrations.  During our conversation we discuss What has caused the rise of semi-synthetic cannabinoids in the market?  How Michelle got involved testing unregulated hemp and cannabis products  Some of the adverse events that have occured from consuming semi-synthetic cannabinoids  How the LS-MS/MS method allows Michelle's team to see compounds other labs can't   How consumers can protect themselves from mislabeled products Whether federal legalization of cannabis would eliminate the semi-synthetic market  Thanks to This Episode's Sponsor: PRICH Biotech PRICH Biotech, Corp. is a vertically integrated company dedicated to the cultivation, manufacture and dispensing of medicinal Cannabis in Puerto Rico.  With over 500,000 square feet of state-of-the-art facilities, Prich uses the highest standards of agricultural and manufacturing practices to guarantee the highest standard of medicinal cannabis. Their mission is to offer a natural and unique experience through medicinal cannabis that raises the patient's well-being and quality of life. Learn more at prichbiotech.com.  Additional Resources Register for CannMed 25 Meet the CannMed 25 Speakers Review the Podcast CannMed Archive

Informal care partners are essential to the care of people living with dementia, but they often experience significant burden and receive minimal training, support, and resources. Multicomponent interventions can mitigate burden and other negative consequences of caregiving. In this episode, Gordon Smith, MD, FAAN speaks with Angelina J. Polsinelli, PhD, ABPP-CN, author of the article “Care Partner Burden and Support Services in Dementia” in the Continuum® December 2024 Dementia issue. Dr. Smith is a Continuum® Audio interviewer and professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Polsinelli is an assistant professor of clinical neurology at the Indiana University School of Medicine in Indianapolis, Indiana. Additional Resources Read the article: Care Partner Burden and Support Services in Dementia Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full interview transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Smith: This is Dr Gordon Smith. Today, I've got the great pleasure of interviewing Dr Angelina Polsinelli about her article on care partner burden and support services in dementia. This article appears in the December 2024 Continuum issue, which is on dementia. Ange, welcome to the podcast. And maybe you can begin by just introducing yourself to our audience?  Dr Polsinelli: Yeah. Well, thank you for having me. I'm very excited to be here. I'm Ange Polsinelli. I'm a neuropsychologist at Indiana University School of Medicine, where I work in the Department of Neurology. I also work with the Longitudinal Early Onset Alzheimer's Disease study that's led by Liana Apostolova. And I also do some work with the Outreach, Recruitment and Engagement Core of the Indiana Alzheimer's Disease Research Center. This topic that we're going to talk about today is extremely near and dear to my heart. Dr Smith: Well, thanks for joining me. And of course, IU is a powerhouse for Alzheimer's and basketball, in that order. So, we're really excited to have you. I'd like to get right into it. I'll emphasize, we were chatting a little bit about this, Ange, before we started recording, that your topic today is so important for all of us. And I think, you know, this is a podcast that not only neurologists listen to, but students and, and I think increasingly members of the lay public. And this conversation is going to be very important for neurologists and our neurology learners. But I lost my grandmother to Alzheimer's disease. I lost my uncle just in the last week. So, this touches all of us. So, I'm really excited. And then with that in mind, I wanted to begin with a statistic that- you can correct me if I misunderstood it, but it really blew my mind. And that is across the world, as I understand it, care partners provide one hundred and thirty three billion hours of care for people living with dementia yearly, which is pretty staggering. But what's really amazing is that by 2030 that number is expected to go to one point four trillion hours, which I couldn't grab my mind around it. So, I figured I'd try and determine how many years of person work is that and if my math is right, that's almost a hundred and sixty million person years of worth caring for people with dementia yearly across the world. One, are those numbers right? Did I get it right? And then, assuming so, can you put a human face or experience to these numbers?  Dr Polsinelli: Yeah, unfortunately those numbers are correct. And with our increasing aging population across the world, that's why you're getting that, you know, exponential increase in care per hours, compounded by the fact that the majority of the caregiving that happens is not done by doctors, physicians, but it's done by these informal care partners, these family members, these friends, these siblings, children, who are providing these really important services and unfortunately not being trained to do this, doing it largely on their own in a lot of respect. But again, these are people who are loved ones of the person living with dementia. There are a variety of kinships, as I mentioned, siblings, children, spouses, friends; and all sorts of age ranges as well. A large majority of them being spouses, and then the second largest majority being children. So, kind of a sandwich generation of people who are caring for parents with Alzheimer's or dementia and then caring for children as well. Dr Smith: Yeah, I was actually struck by the statistic that a quarter of caregivers or so called sandwich caregivers; in other words, they're taking care of a parent and a child. But listen to what you said. But just to call it out, two-thirds of care partners are women, which is a striking statistic.  Dr Polsinelli: Absolutely. Women are not only more likely to have dementia, but they are also more likely to be the care partners of somebody who has dementia. And so, the research shows, too, that if you're a care partner, you're at higher risk of developing dementia yourself. So, there's a lot of risk for women when it comes to dementia, development of dementia, but also that the burden and the majority of care needs that are that are supported by women as well. Dr Smith: Right. And there's a lot to unpack in that observation, and maybe we can come back to that. But I wonder if you might talk to us a little bit about the risk of dementia in women caregivers. That's really striking. Is there any thought regarding mechanism for that? Why is that the case? Is it a shared risk factor? Is it cause and effect? What's the story?  Dr Polsinelli: So, there are - this is kind of a dissociable or different - kind of two aspects to this, this question. There's the fact that women are at higher risk for developing dementia in general. I think the researchers feel sort of out about why exactly that is. It's not just that women are at higher risk or more likely to develop dementia because they're living longer than men, but there's probably some hormonal aspects of their higher risk factor for dementia. But then there's the other aspect of it too, is that as caregivers, caregivers are at higher risk of developing dementia. And because caregivers tend to be women, that increases or compounds the risk for women as well. We know with caregiving, particularly with someone who's living with dementia, there's more risk of developing things like depression, high stress, health problems, psychological distress, and all of these things increase somebody 's risk for developing dementia as well. Dr Smith: So, I wonder if you might talk a little more, Ange, about what you mean by burden? I think we have in our mind what that is. But in reading your article, there's a lot of- a lot more to it than may meet the eye. Dr Polsinelli: Yeah, it is a more complicated, I guess, topic or terminology that's gone through several iterations over the course of doing research into burden. But when we think about burden, it's really a kind of a combination of both objective experiences and subjective experiences. And these objective, subjective experiences fall into the categories of physical burden, emotional burden, psychological burden. So, there's a lot of different areas of life in which someone can experience burden. But really, it's a combination of factors of both the objective experience, lived experience, and the person 's perception of that experience or what they're dealing with. I should also mention that it appears to be more of that subjective experience or that perception that people have of their objective experience of stressors or burden. That really does determine the person's response to that, if whether they actually perceive their lived experience as being burdensome.  Dr Smith: One of the things I found really interesting was the societal and cultural context surrounding this, that there are different cultural expectations and societal dynamics, both in the nature of the burden care partners may feel and how they're viewed. I wonder if you could talk about that? I think it's something that it would seem all of us need to be attuned to as we're working with our patients and their families.  Dr Polsinelli: Yeah, this is a topic we could talk for a very long time on. I will try and- I will try not to kind of provide too much of a, or too lengthy of a response. But what we know now is basically that our models of stress and burden that we have typically used or historically used do not incorporate a lot of factors of cultural identity of social and structural determinants of health factors. And so, what we understand now is that stress and the way that people perceive burden is influenced by so many other factors than just kind of an experience and a perception. Because that perception is influenced by so many factors, including, as you mentioned, cultural factors that include how society's familial expectations for us, cultural expectations for us, as well as what our resources are that are determined by, again, structural and social determinants of health, what our community resources are. They're just a lot of different factors that go into how somebody perceives their ability to cope with, again, this kind of life-altering diagnosis that their loved one has received and them being the person who is caring for them through that. Dr Smith: Your article actually goes through in some detail the types of burdens and what drives the burden. And that changes over time. And so I wonder if maybe you can talk a little bit about what the specific natures of the burden are from the caregiver perspective. I mean, what  sort of tasks there are, you know, from the many of us who take care of patients, we still don't know unless we've been in the room or in the home watching this happen. So maybe you can describe that for those of our listeners who maybe haven't lived through this?  Dr Polsinelli: Yeah, absolutely. I will say upfront that the caregiving experience is going to be different for every single person. And again, kind of dependent on some of those factors that I mentioned before. So, it's going to look different for most people. It's also going to look different through the dementia journeys. The experiences and the requirements earlier on in dementia are going to be a vastly different than what occurs later on when dementia is in the more late stage, moderate or severe stages of the disease. Those care responsibilities absolutely change over the spectrum of that time as well. We know that early on the stage of disease, primary care partner might be spending forty plus hours a day. So, a full-time- or not a day. I'm sorry, a week. So, a full time job carrying it. But that number increases up to a hundred and fifty or so hours per week once the person is more advanced in their disease. So, I say that because the number of hours, I think, make all, like- putting that into perspective of somebody having a full time, multiple full time jobs, basically providing care, I think is really important. But the responsibilities of the care partner are going to range from everything from just helping the person early on in terms of managing finances or managing them, making sure they're reminding them to take their medications, scheduling their medical appointments for them, maybe taking over all of the driving to get them to their appointments or to get them to family outings and things like that. They're going to be the ones that's going to be the most responsible for reminding people to do something: to eat, to maybe stay on track for a recipe or something that they are making. So, kind of being the eyes and ears for this person right away, basically right at the beginning, even early stages. And then that progresses over time to the person who is caregiving, who is doing potentially everything for this person. So that means helping them use the restroom when they need to, helping them shower. So, there's a physical component to the caregiving as well as that- sort of what we call instrumental support in terms of organizing medical appointments and things like that. They're just basically doing it all for that person.  Dr Smith: So, what about a busy clinician who has half an hour to see a dementia patient follow up? Kind of hard to- in these days, you know, we've got, you know, these new therapies to think about as well. What advice do you have to neurologists and other professionals caring for patients? Dr Polsinelli: Yeah. And I think neurologists, I mean, we all have limited time. And I know neurology in particular is like primary care, has even more constrained time. I think one of the biggest things that neurologists can do is really check in with the care partner. So, take a moment to check in with the care partner who's there with the person with dementia to see how are they doing. You're looking for signs of burden or stress, so things like physical complaints like headaches or stomach ache, mentioning feeling burnt out or overwhelmed, maybe feeling depressed or something like that. There's also some short kind of questionnaires that you could give care partners prior to an appointment that they could fill out. You could kind of get a sense of where is this person at this point and then help connect them potentially to some resources that might be available. And I would refer people to that article that has a list of resources in there that you could just basically print out and give to somebody.  Dr Smith: Yeah, I was going to make the same point, Ange. Your article is a treasure trove of information. And you know, I'm certainly, I keep all of these on file, as you might imagine, but I'm keeping it in hand for future use. One of the things you talk about that really hit home for me among many is the idea of self-care, and I think sometimes the best care partners are susceptible to burnout because they they're so dedicated. You made the airplane oxygen mask metaphor, which I love. So maybe you can talk about what airplane oxygen masks have to do with dementia care and what advice you have for us and helping our patient's care partners take care of themselves? Dr Polsinelli: Yeah, absolutely. Self-care is the number one thing I tell care partners to do. It's also one of the hardest things for care partners to do. Like you mentioned, there is a deep, generally speaking, a deep love and caring for the person with who is living with dementia. And the focus becomes on them. And understandably so, the care partners sort of loses focus on themselves and making sure that they're doing okay. So I oftentimes use this oxygen airplane metaphor for people, which is basically, you know, when you're in an airplane and if there's some kind of pressure change in an airplane, they always tell you, put your oxygen mask on first before you help somebody else because you're not going to be any good to anybody if you're passed out. In the airplanes, the pressure changes, you know. You need to be available. you need to be getting what you need in order to help somebody else. So, I think that metaphor, that analogy really works well in dementia care is you need to be- the care partner needs to be caring for themselves and replenishing themselves in order to be the best care partner they can be for their loved one.  Dr Smith: Another challenge that, it strikes me as shared between people living with dementia and their care partner is that of social isolation and loneliness, right? If you're working a hundred and fifty hours a week doing anything, you don't have time to care for yourself or very hard to engage in social connections. And one of the loud messages I think I heard from your article is the power of social connectedness, both in terms of resilience and in many different ways. I wonder if you can talk a little bit about loneliness? And I just reflect that in a postpandemic world, this is probably a bigger issue than it was four years ago or four years and three months ago. Dr Polsinelli: Yeah, absolutely. Loneliness and social isolation was a big problem before, and it's even worse now is when I'm hearing from my patients. What I'm seeing in the literature is this postpandemic time is even more has been even more isolating and more problematic for people, but this social network cannot be, as you said, it cannot be overstated in terms of the importance for people. So that social network is important for not only providing potential instrumental care - so that practically care that care partners can use can lean on other people to come into the home to do things for the person living with dementia so the care partner can go practice self-care or go do those errands that need to be done - but also the emotional support as well that social networks can provide for people. And also, you know, social networks for not just the person, the care partner, but for the person living with dementia as well. We know that social engagement in particular is really good for brain health. I mean, we don't think about it, but social engagement is a very cognitive activity. And so, it helps give the brain a bit of a workout. So that social network is important for a lot of different reasons, and understandably a lot harder to maintain in this sort of postpandemic world as well. Dr Smith: As our time starts to come to- close to a close, we're not done yet, but I think we're probably going to have to start winding up. I wonder if we could pivot to something positive and then talk about the joy in this. And by that, I mean you describe and I think we've witnessed relationships and caring, caregiving situations that, as challenging as they are, provides fulfillment and the connection one has with a loved one or sort of that social aspect. Are there things that- predictive of that kind of positivity, and are there ways that we as professional caregivers for patients and their families can facilitate that? Dr Polsinelli: Yeah, there are. There are a couple of things. So, one of which is basically the quality of relationship between the care partner and the person living with dementia already. So that's the quality of that relationship. The better the quality of that relationship, the more likely it is that the care partner will experience more meaning and fulfillment and joy associated with caregiving, kind of outweighing that burden. But the additional piece of that is the more resources, the more mastery they feel about their caregiving or care partnering abilities, the more competent they feel and their ability to do good by the person, their loved one, the person living with dementia, the more likely they are to find that role fulfilling and meaningful. And I think that's where neurologists and other providers can kind of come in as helping people make sure that they have those resources that they are connecting to places where they can learn skills for giving appropriate care so that they can feel confident in what they're doing. There's the preexisting relationship piece that matters a lot. But I think that there's a lot of modifiability that neurologists have, too, in making a positive impact on the care partner and the person living with dementia. Dr Smith: That's really great advice, Ange. And I definitely will refer our listeners yet again to your article, which is a compendium of useful advice about this, both in terms of the text itself and in tables that provide lists of resources, websites, books, organizations, good case examples. It's a home run and I hope all of our listeners check it out. I'd like to wind up by talking a little bit about your work. And as I understand it, you obviously are very passionate about this topic, but you have specific interests in caregiver burden and underserved and marginalized communities. And then, we've touched on this, but this is a huge percentage of our population. And when you look out globally, it's even bigger than that. Tell us about what you're working on. And then maybe following that, what's the future look like? Where are we going to see advances in this in the coming years?   Dr Polsinelli: So just a really quick kind of brief history is that I've worked in dementia for almost twenty years or so now. And what I've consistently seen is when you give care partners good supports and education and resources, there are better outcomes for them and their families. The unfortunate thing is, a lot of these really great interventions and things that we have are not necessarily really accessible by a lot of people, but particularly not accessible by those living in underserved communities. The last few years in particular, I've really shifted into wanting to better understand that and better understand how do we provide culturally and socially appropriate interventions and education for these care partners and their families. With the current research project that I'm working on, we're looking at better understanding the needs of care partners of people who have early onset Alzheimer's disease, specifically from Black and African American individuals and other underrepresented groups. Again, the idea of this is to understand the needs before building an intervention for these groups, and I'm very excited about it. I know that there are lots of really great people who are working in this area, including Dr Dilworth Anderson and Kalisha Bonds Johnson, doing really fabulous work in this area. So, and building on what they're doing as well. In terms of what the future holds, one, I think we absolutely need to, we have lots of really great care partner interventions out there that have been lots of research going on, but it's not really transitioning into the clinical sphere. It's really kind of staying in that research sphere. So, I think it's really important that we get some implementation scientists who are taking those interventions and moving them into the clinical sphere, into the sort of like everyday, how do these actually work for people sphere. And then similar to some of this conversation we're having in terms of serving, making sure our interventions and making sure that our resources are appropriate and accessible for underserved communities, we really need to be taking a look at what these communities need rather than kind of saying, this is what's available. Kind of, hopefully this works for you. Speaking with these communities, engaging stakeholders and understanding what are the needs in these groups so that we can provide the appropriate resources, the appropriate interventions, the appropriate supports for care partners and people living with dementia. Dr Smith: And I'm just thinking, imagine what this looks like with effective treatments for Alzheimer's disease, that slow progression. And you know, that's going to make the caregiving even more important, it seems to me. But there's an opportunity to make it a better rewarding and a better-supported system as we develop these new therapies. So, this is a, like a Clarion call for learners listening that they should all become dementia neurologists and neuropsychologists like here. Thank you. That was outstanding. Say, Ange, I want to thank you a lot for a really engaging conversation. This fulfilled every hope I had coming into it. I was really excited to talk to you. I always love talking to neuropsychologists, but I think again, this is really useful for neurologists, learners, people who are nonneurologists everyone. And so, thank you very much. I've learned a lot and I really would encourage everyone to check out the article.  Dr Polsinelli: Well, thank you so much for having me on and giving me the opportunity to talk about the stuff that is really important to me and, I think, to most of us out there. So, hopefully people find the article and the resources in there useful and, and thanks again for having me.  Dr Smith: I'm sure they will. Again, today I've been interviewing Dr Angelina Polsinelli, whose article on care partner burden and support service in dementia appears in the most recent issue of Continuum, which is on dementia. Be sure to check out Continuum audio episodes from this and other issues. And thanks to you, our listeners, for joining us today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.